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Taking Insurance in AAC Private Practice: Pros and Cons

Deciding whether or not to take insurance for your private practice is a complex question with no one-size-fits-all answer. To make the best decision for you and your business, it’s important to weigh the pros and cons of taking insurance—and be sure to consider any specialty services you plan to offer. I’ve been a Speech Language Pathologist (SLP) in private practice for five years, specializing in Augmentative Alternative Communication (AAC). During this time, I’ve learned that taking insurance is a must if you want to build an AAC practice. However, I have also learned the hard, hard lessons of what insurances to take and how to managed which contracts we get involved with. So let's discuss the pros and cons of insurance.

The Pros of Taking Insurance

First, let’s look at some of the benefits associated with taking insurance in private practice:

Expanded Patient Base:

Taking insurance gives you access to a larger patient base than if you only accepted private pay. This can be especially beneficial if you specialize in services that are rarely covered by private pay, such as AAC therapy. The fact that most of the patients that require services who are in need of an AAC Specialist have life long conditions which means they are rarely discharged from services. This means the cost of therapy to a family over the life-time of that child is astronomical and not sustainable on private pay.

Stay Competitive

If your competitors are taking insurance, then it may be worth considering so as not to lose out on potential patients who require coverage from their insurer. I have found this to be particularly true as if there are insurances that another practice may take and you do not those families will go to the other practice even if they do not have AAC services. Families are not very well versed in why AAC requires a specialist and so education on the matter is a must. You will not be able to give that family that education if you cannot get them through the door.

Makes Your Business Easier to Scale

With an influx of new patients comes an influx of new paperwork and processes that need managing. Taking insurance can help streamline these processes, making it easier for your business to scale up quickly and efficiently.

Helps with Marketing

Having the ability to accept major insurers makes marketing much easier because it gives prospective patients peace of mind knowing that they will have coverage for their treatments. Insurance companies will also put you on their list of approved providers which makes finding patients much easier.

The Cons of Taking Insurance

Now let's take a look at some potential drawbacks associated with accepting insurance:

Contracted Rates

All insurers have their own contracted rates and when you sign with them then you are accepting that rate as payment. The rest will be plan dependent on the individuals plans. This means less money coming into your pocket and can eat away at profits over time if not accounted for properly when setting rates. I have had the misfortune of learning this lesson the hard way and not truly understanding what these contracted rates meant for the overall bottom line of my practice.

Complicated Application & Set-Up Processes

Applying for contracts with major insurers is often a long and complicated process that requires extensive paperwork, background checks, credentialing requirements, etc., which can all add up quickly when done incorrectly or inefficiently. This is probably one of the most important parts of insurance and is the most easiest to mess up. If you do not truly understand how to credential your practice, your clinicians and etc to the insurer you will get denial of service and could be out tens of thousands of dollars.

Benefit checks & Pre-authorizations

Even once contracted with an insurer there is still extra paperwork involved such as pre-authorization verification which must be completed before every initial treatment session in order for reimbursement requests to be accepted by the insurer—adding extra administrative tasks onto already busy schedules!

Restricted Number of Treatments

Many insurers place restrictions on how many treatments a patient is allowed per year which can limit how many treatments you are able to complete overall—this could put a strain on your business if not addressed properly when setting up billing and scheduling practices prior to starting work with insurers and families.

When deciding whether or not you should take insurance as part of your private practice, there are plenty of pros and cons that should be weighed carefully before making any decisions. As someone who has worked with both models successfully over the past five years, I believe accepting both private pay and insurance offers the most benefit overall; however this may not always be true depending on what type(s) of services you offer within your own practice!

Ultimately only YOU know what will work best given YOUR unique circumstances so take time out now before diving into anything too deep so that YOU make THE RIGHT CHOICE FOR YOU!

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