The Truth About Insurance Credentialing: What Hawaii Therapists Really Need to Know

Frequently Asked Questions

• 1.     I don’t want to take insurance; I just want to do private pay. Why even bother with insurance credentialing?

  Many clients in Hawaii want to use their insurance for therapy sessions. In fact, in a survey I conducted on April 5, 2024, among 40 therapists, 88% said their Hawaii-based caseloads were at least 80% insurance-based! So, if you want your Hawaii-based caseload to be at least halfway full, it will really benefit you to accept at least a few insurance plans.

• 2. Can’t I just pay someone to do my credentialing for me? I just don’t have time to do my own credentialing because I have a million things going on right now between (fill in the blanks: working 2-3 jobs, taking care of my relatives, etc).

  As a therapist, business owner, and mom, I hear you. Life is busy, so it makes sense to want to delegate certain administrative responsibilities (like this one) to someone else.

  However, I typically discourage clinicians from hiring credentialing services for several reasons (while also walking them through the process of doing their own credentialing):

  a.      You’re paying someone a lot of money to do something you were actually able to do back in high school.

  If you’ve ever filled out a paper job application, especially for a minimum wage job, then I promise you- you have the skills that it takes to complete insurance credentialing applications. Yes, it’s tedious and somewhat time-consuming, but it’s definitely doable.

  Just to put it into context- when I did my own insurance credentialing for my private practice, I was working at a group practice that required me to see 35-40 clients a week (yikes), and my children were 3-years-old and 17 months old at the time. I was definitely busy! So, I worked on insurance credentialing applications during their naptime for one day per week for one month (i.e. a total of 3-4 nap times). 

  While your structure and life might look a little different, I share this as a tangible example of how easy it is to complete insurance credentialing applications no matter how much you have going on.

  b.     The credentialing companies often don’t do it right, or they miss steps, or you feel lost with regards to where your credentialing applications are at in the process.

  I know several therapists who paid a credentialing company $110-$300 per credentialing application. From there, the therapists still had to do a lot of legwork themselves either due to missing steps, or because of the company not following up with the provider properly.

  c.      Several companies will only do your credentialing if you also agree to let them do your billing.

  Just like credentialing, you can easily do your own billing. Many EHRs can help you to do your own billing easily.

• 3. What about Rula, Headway, Alma, or Mentaya? What if I just join one of those instead of getting credentialed with insurance?

  While these companies may have their benefits, they do have their drawbacks, particularly in Hawaii. I’ll go through these one by one-

  Rula- you’ll only get paid about $60-$70 per 53-60 minute session. However, most insurance plans in Hawaii will reimburse you at $116-$132 per 53-60 minute session. If you’re seeing multiple clients a week, that pay difference adds up quickly.

  Headway- While I heard that Headway recently included Kaiser and HMSA in its Hawaii-based panel, I also heard of an incident from a clinician who lost her calendar and important client data due to a Headway-related glitch. She did not recover most of this.

  Alma- Alma is not available in Hawaii.

  Mentaya- Mentaya is a service that allows you to collect your private pay fee from the client while simultaneously submitting an out-of-network claim on your client’s behalf so that your client can receive reimbursement for the session. While this may work well for many private pay practitioners, private pay is not a popular option for therapy in Hawaii, as the vast majority of clients want to use their insurance plans for therapy. (see my FAQ #1).

• 4. I’m scared to death of insurance clawbacks and audits! I don’t want to work with insurance!

  A lot of therapists who start working in Hawaii after working in other states share this one! I want to assure you that, while insurance audits and claw backs do happen in Hawaii, they’re not that common. To put it in perspective, I knew of a therapist with over 15 years of private practice experience in Hawaii who only ever got audited 3 times- and none of those times really amounted to anything substantial.

• 5. How long will this take me? And how do I figure out how to do my own credentialing?

  As mentioned earlier, you can set aside about 30-45 minutes per insurance credentialing application (or about one hour for HMSA or Medicaid). If you credential yourself with 3 insurance companies, that’s just 1.5-3 hours total (or 3 weeks of 30-60 minutes per week if you want to space that time out a bit).

  If you look at this and still feel tempted to pay someone to do your insurance credentialing, let me ask you this- do you really want to pay someone $110-$300 to do something that only takes 30-45 minutes?!

  If you’re intimidated by the idea of doing your own insurance credentialing, I’ve got you covered. In my De-Mystifying Insurance Credentialing course, I will do a step-by-step walk through of certain insurance credentialing applications. Use the code THTH20 at checkout to get 20% off!

  I will also provide you with all of the insurance credentialing applications, and contact information for each insurance company so that you can confidently check in on the status of each insurance credentialing application: https://www.thehawaiitherapisthub.com/de-mystifying-insurance-credentialing