Provider Networks To join or not to join-that is the question?

How do they work? Let's step back to the beginning to see how networks operate. As opposed to a physician provider network, a specialty network will contract with insurance companies to provide healthcare services for their members or enrollees.
These services may include chiropractic care, massage therapy, acupuncture and/or dietitian services. Before and after the contract is established with the insurance company, the specialty network will recruit the appropriate specialists in target states as well as to fill the need for that specific contract. Contracts are established on a state-by-state basis and dietitians are recruited on a state-by-state basis as the need arises.

There are two types of contracts that the specialty network may establish. One is called "access" or "affinity" where dietitians agree to give members a 20-25% discount in exchange for listing in the provider handbook. The other is "benefit" where direct reimbursement is given to the dietitian in exchange for services rendered to the member (patient).

Reimbursement rates will vary from network to network so it is important to ask about rates up front. Some networks however have very competitive rates. Most of the networks pay more then Medicare and in some cases the rates are 100% of your usual and customary fees.

Claims turnaround times are usually more rapid then the horror stories you may have heard from RD's that contract directly with health plans. Most health plans are set up to accept claims predominantly from MD's. Thus when a claim comes in from a non-MD provider the system will often reject the claim and kick it over to be processed by hand. All this extra processing can prolong the payment timeline. In a network that actively contracts with dietitians, the RD claim is accepted into the system and the payment is more routine and timely.

I participated in a specialty network when I had my private practice. From a personal point of view, I found it to be a great business opportunity as the volume of patients made the discount worth my while. It is still up to you to promote yourself. Many dietitians become frustrated when they don't get tons of calls from simply being part of a provider network. Being in a provider network is not a substitute for marketing yourself. Once you are accepted on the "wholesale end" you still need to sell yourself on the "retail end," so to speak.

To join or not to join-- It is obviously a simple answer. It's a win-win situation--you can't lose. For more information, contact the American Specialty Health Networks recruiting line at 888-511-2743.

Beverly Price is a Registered Dietitian, author, newspaper columnist and public speaker who made a name for herself with her unique approach to nutrition counseling. After 11 years in private practice, she sold Living Better Sensibly -- one of the largest private nutrition practices in the country - to an independent nutrition-counseling firm, and started Jump Start Consulting specializing in management and marketing strategies for dietitans and other healthcare professionals, along with distance learning products for continuing professional education. http://www.gettingthatjumpstart.com/