Steven Walfish, Ph.D.

An often-cited advantage of joining a group practice is that it can help a clinician get on an insurance panel. This may be especially advantageous if the group itself (not just each clinician) is considered to be paneled then the: (a) paperwork is streamlined, and (b) clinician will not be shut out of the panel if it is closed. The group facilitates the development of a managed care practice, and if the practice is well established in the community, referrals to the new clinician may flow quickly and be plentiful.

When a clinician is paneled thru a group practice, the billing is done using the Tax ID number of the group practice, not the individual clinician’s Tax ID Number. In consulting with a clinician in the Northeast this past week a light bulb went off for me regarding this arrangement that had never occurred to me previously.

Question: What happens to your ability to see clients on your current caseload if:

  • You decide to leave the practice?
  • The practice asks you to leave?

If you decide to leave the practice to open your own office, or join another practice, you lose membership on the insurance panel (unless the panel is specifically looking for someone with your skill set or specific location). This is because your membership is tied to the original practice in which you were paneled. Therefore, if you know that you are going to leave the practice, and want to remain on insurance panels, you have to apply for panel membership on your own. If this is the case, give yourself plenty of advance notice to make application. Also be prepared to be denied if the panel is closed.  Of course clients may follow you to your new practice and see you as an out-of-network provider if they want to do so. If they choose not to, be prepared to make an appropriate referral.

However, what if the practice asks you to leave and you were not prepared to leave? All practice contracts should have a clause under which the clinician may leave the practice or the practice may ask the clinician to leave. This usually include a time frame (30,60,90 days) when a decision is made to move on or to sever the professional relationship. However, 30, 60, 90 days is often not enough lead time “to get paneled.”

In addition, most contracts have a clause that indicates the contract may be severed immediately “with cause.” That is, either the practice or the clinician deems that a wrong has been committed (e.g., unethical or illegal behavior, malpractice).  Under the circumstance where the clinician is asked to leave the practice, it appears they also immediately lose their membership on the panel. They cannot see clients on an in-network basis.

At The Practice Institute when we review contracts clinicians are asked to sign when considering joining a practice we often ask, “If this works out will you be happy that you signed the contract? And “If this doesn’t work out will you be happy that you signed the contract?” It appears to me that if a clinician is asked to leave a practice before they are ready, it will jeopardize their ability to remain paneled and be an in-network provider.  It may seem like a major benefit in joining a group practice that you will be immediately paneled, that this likewise may become a double-edged sword if the practice decides to terminate with you prior to your own planned exit.

The moral of the story: If you are going to be paneled, it is always best to work towards being paneled on your own, rather than having your status tied to a group practice.