Closed Insurance Panel? Here’s How to Appeal

You’re ready to get contracted with insurance companies and you’ve reached out to Healthy Bytes for help. You’ve identified your top insurance companies to start with and can’t wait to grow your client base!

But what happens when you apply to become in-network with an insurance company and you learn that their panel is closed? When an insurance company's panel is closed, this means that particular company has temporarily stopped accepting new dietitians into its network in a certain geographic location. Although the reasons vary, it's most commonly a result of the insurance company feeling they have adequate coverage for a given area. Contact the insurance company (or have us do this for you) to learn if there is any other reason why they may have turned your application away. Regardless of the reason, you do have options and Healthy Bytes can help.

You could opt to wait for the panel to open and check back with the insurance company every three to six months, or have Healthy Bytes check more frequently on your behalf. In addition, you can also file out-of-network claims, which some companies do reimburse for. You may also file an appeal if you wish to make the case for becoming in-network. Let’s explore this last option.

Option: Appeal Your Status

Appealing a closed panel is not a guarantee that you will be accepted as an in-network provider, but providing the insurance company with specific, detailed information in an appeal can improve your chances. You must have a valid reason to present to the insurance company. Sample reasons that justify an appeal that will be viewed more favorably include one or more of the following:

  • A list of clients that you have had to turn away due to your out-of-network status, including a list of their requested appointment dates.

  • A detailed explanation of your services and proximity of the closest dietitian with similar services. Generally, insurance companies will consider an appeal when there are no other qualified dietitians within a 30 mile radius.

  • A mention of your niche area of practice – perhaps you’re the sole Certified Diabetes Educator in your particular geographic location, for example. State the value of this specialty to prospective clients.

  • A description of your specific, unique skill set and how it will benefit the insurance network – do you speak a second language, making you more accessible to a certain subset of the insurance company’s members?

  • Names of physicians who have expressed interest in referring their patients to you, but who are limited by your out-of-network status.

Contact the insurance company to learn how they wish to receive the appeal (or, again, have your Healthy Bytes billing experts do this on your behalf). Confirm receipt of your appeal once you have submitted it, and be persistent and follow up with the insurance company. Your clients need access to your nutrition expertise – you’ve got this!

Have you successfully filed an appeal that was accepted by an insurance company? Please share below!