Last Updated: Dec 14, 2017
Physicians, especially new physicians, find themselves unable to treat privately insured patients until they are fully credentialed by insurance companies—a lengthy and oftentimes frustrating process that creates administrative hassles and delays patient care.
To confirm the level of this frustration, the Pennsylvania Medical Society (PAMED) recently polled members through its daily email, the Daily Dose.
While this was only an informal poll, it confirmed that, as expected, at least half of the problems occur when attempting to credential a new physician. Physicians’ biggest hassle is that the process simply takes too long. Most respondents said it took more than 90 days (50 percent said the process took 90 days; 23 percent said it took 120 days, and 13 percent said it took 120 days.)
The majority felt that the main contributing factors to the delay were the health plan and the cumbersome application process, and they said that that delay cost them money (33 percent said $20,000-$40,000, 22 percent $45,000-$60,000, 22 percent less than $10,000, and 15 percent more than $80,000).
When asked what they considered a reasonable time period for commercial insurers to complete the credentialing process, provided that physicians were able to retroactively bill for dates of service that coincide with the effective date on the credentialing application, 46 percent said 30 days and 39 percent 60 days.
PAMED believes that payers should be required to make a credentialing determination within 90 days of receiving a completed application and to reimburse provisionally 15 days into the credentialing process. We have drafted legislation and are in discussions with a potential bill sponsor in the House. In addition to easing the burden on physicians, this bill would also help ensure access to care and reduce their out-of-pocket expenses for patients.
“What we currently have is a private health insurance credentialing system or process that is at best inefficient, blind to the needs of patients residing in rural and underserved areas, and unfair to newly trained physicians who simply want to begin putting into practice the skills they have learned during nearly a decade of training,” said former PAMED President Bruce MacLeod, MD.