Is Going In-Network Worth It for Your Practice?
Going in-network with a medical payer is a real, worthwhile move for some practices, and unnecessary work for others. This article walks through how to think about it, so the decision is based on your actual situation rather than a general assumption either way.
What going in-network actually changes
Being in-network means signing a contract with the payer, agreeing to their fee schedule in exchange for more reliable processing: faster approvals, predictable payment, no need for gap exceptions on HMO/EPO patients, and (in many cases) a better patient experience since more of their plans will actually pay something. In exchange, you can't bill above the contracted rate for covered services, no matter your normal fee. If the in-network/out-of-network distinction is new to you, start with In-Network vs. Out-of-Network.
The real cost: time, not difficulty
The credentialing process itself — maintaining a CAQH profile, submitting payer-specific enrollment forms — isn't especially hard. What it requires is time: typically 60 to 120 days per payer, sometimes longer, and it's mostly out of your control once submitted; payers move at their own pace. This means it's not something that helps in the short term. If you're weighing whether to pursue it, think in terms of months, not weeks.
Questions worth answering before deciding
How much medical billing volume are you actually generating with a given payer? If one payer represents a small share of your patient base, the setup time may not be worth it yet. If you're seeing that payer constantly — especially for the same one or two payers — the case gets stronger quickly.
How dense is your market for the specific services you're billing? If you're in an area with several other providers offering the same services (Botox, TMJ, sleep appliances) and you're out-of-network, you're more likely running into denials that going in-network would resolve. If you're one of few providers offering a given service in your area, you may already be getting reasonable outcomes through gap exceptions without needing to go in-network at all.
What does your actual denial pattern look like so far? After a stretch of real claims, look at what's actually happening. A high rate of HMO/EPO denials with a specific payer is a strong, concrete signal that going in-network with that payer specifically would change outcomes. A pattern of mostly PPO claims processing fine at out-of-network rates is a signal that going in-network may add less value than expected. (Reading a Denial covers how to tell a structural HMO/EPO denial apart from a fixable one.)
Are you willing to accept that payer's fee schedule? Sometimes an in-network rate for a given procedure is lower than what you'd otherwise collect between patient payment and a strong out-of-network reimbursement. This is worth comparing directly for your highest-volume procedures before committing.
A reasonable way to approach this
Rather than deciding upfront, let your first stretch of real out-of-network billing generate the data that answers this question. Once you can see, payer by payer, how often you're running into HMO/EPO denials versus getting reasonable PPO outcomes, the decision becomes much clearer — and it becomes a decision about a specific payer, not a blanket "should we go in-network" question.
If you decide to move forward
Credentialing execution (filling out and submitting the applications, following up with payers) isn't something to take on casually alongside running a practice — it benefits from someone whose job is specifically to track and follow through on it. If this is a direction you want to pursue, it's worth discussing with your Coral contact, who can point you toward vetted options for handling this.