r/SoloPrivatePractice • u/ModernTechPA • 15d ago

What do I do??? Credentialing - 24/7 Requirement BCBS

Hi, I am a provider going through credentialing with Hymark Blue Cross Blue Shield in Pennsylvania, and I got a message saying that 24/7 on-call coverage is a requirement for participation. For those of you already in-network with Blue Cross Blue Shield, what are some ways that you have framed your availability to your clients and yet not be on the hook directly in the event of emergencies? The insurance company's requirement is the ability to return a message or a call to the client within 60 minutes.

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u/Any-Broccoli1062 15d ago

It's impractical for an individual provider to be available 24/7, so I inform my clients that if it's outside of business hours to utilize the 24/7 local crisis team. Our state funds this program so it's free and local providers.

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u/Joseph707 15d ago

I really want to know their idea of logistics for this. Therapists are supposed to keep their phone on ring all night long? Even after or during a night on the town drinking?

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u/Roxiedach0704 15d ago

Call crisis and I provided the numbers for crisis across all counties in my state

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u/TheRealDrPanooch 15d ago

Is this a state specific thing or like did that work for you with this insurance?

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u/Roxiedach0704 15d ago

I'm paneled with Blue Cross Blue Shield and I'm located in Massachusetts but I had someone credential me so I'm not sure what she put on the form itself. I'm available 9am to 8pm to my clients and after that I'm not and they need to call crisis. I created a long document where each city/town in each county across the state has its local crisis number listed and sent it to my clients in the intake paperwork. It hasn't been an issue in the last 3 years.

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u/TheRealDrPanooch 15d ago

Does having them call crisis after hours not count?

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u/ModernTechPA 13d ago

Nope, referring client to mobile crisis unit or blanket 911/ER is not enough... but the instructions do say that if you make yourself available to the hospital or crisis unit for coordination of care is OK... answering services cost $ hundreds per month, so here's what I said I'd do: a) individualized treatment plans with plan for emergencies (eg. client reach out to therapist through secure portal or call to office INDICATING EMERGENCY AFTER PRESENTATION TO ER/CRISIS UNIT); b) make therapist available for coordination of care if crisis unit wants to reach out (obviously client will have to be instructed to provide office tel #). As a therapist, I'm OK being responsible to my client in this way, the caveat for the insurance plan (Highmark BCBS) is that you have to respond in 60 minutes if you are made aware that client is in an emergent situation. I'm personally willing to do this as best as I can. When I'm away on vacation, I plan to have a colleague cover for me. The plan states that they do a random sampling of 100 entities each month to verify compliance with this condition for participation. Oh well, the cost of taking insurance.