That’s why I’ve put together this handy guide on the top healthcare payer companies in the USA. Whether you are trying to change your insurers or just simply want to be well informed, this blog post will get you inside information about payers that just kill it on provider satisfaction, claims processing, and ease of doing business altogether.

So, grab a cup of coffee—or if that is not your style, then tea—and let us dive together into the world of the healthcare payers. By the time you are done reading this, you will know way better what companies you should consider for your practice. Let’s begin!

What is a Healthcare Payer?

A healthcare payor, also written as a healthcare payer, is an organization that covers the expenses of healthcare services its members receive from credentialed healthcare providers. These payors can be government and private insurance providers, such as Medicaid and Medicare (government programs) and other commercial insurers.

Payors offer patients various health plans. A slight difference between a payor and a health plan is that the health plan includes all the details about covered treatment procedures and their costs, while the payor is the entity responsible for processing patient enrollment, services, and payments.

Insurance payors pay both healthcare providers for services rendered to their covered patients and patients if they receive services from out-of-network providers with the consent of their insurance provider. In the latter case, the patient pays healthcare providers out-of-pocket for services received and then submits claims, in the form of a superbill, to their insurance payor to receive payment for covered care services.

Top 5 Best Healthcare Payors Companies in the USA

Choosing the best healthcare payor in the USA requires careful consideration of several important factors. Healthcare providers need a partner that ensures reliable reimbursements, comprehensive insurance coverage, and a long-term, trustworthy relationship.

Below is a list of the top-rated healthcare payors, known for their excellent services, timely payments, and commitment to both providers and patients.

1⃣ Kaiser Permanente

Kaiser Permanente is a trusted name among the best healthcare payer companies in the USA. It provides reliable coverage and high-quality care. With over 12 million members across the U.S., they have built a strong reputation. For healthcare providers, teaming up with Kaiser has some great benefits you might not find elsewhere.

First, because Kaiser has so many members, providers get a steady flow of patients. This means more chances to grow your practice and have consistent income. Plus, Kaiser’s closed network makes it easier for providers to work together and share patients. You can coordinate care smoothly with other professionals in the network.

Another bonus is predictable payments. Kaiser has set schedules for reimbursements, so you know when and how much you’ll get paid. This helps you plan your practice’s budget without surprises.

Kaiser has been around for over 75 years, so they bring a lot of experience to the table. Working with them means you can build long-term relationships and see your practice grow. Their focus on patient-centered care is something that aligns with most providers’ goals – offering quality care and good health outcomes.

Kaiser also invests in new tools and technology to help healthcare providers. You’ll have access to the latest resources, which can help take your practice to the next level and offer your patients the best treatment available.

And, with Kaiser’s big presence in states like California, partnering with them gives you the chance to reach more patients in popular markets. You’ll have access to a larger group of people who rely on Kaiser for their healthcare.

For healthcare providers, Kaiser Permanente is a great partner. They offer financial stability, the chance for growth, coordinated care, and tools to improve your practice. With their focus on both patients and providers, Kaiser is a smart choice for healthcare professionals.

So, if you’re looking for a trusted, reliable partner, Kaiser Permanente might be just what you need!

Click Here To Get Credentialed with Kaiser Permanente

2⃣ United Healthcare

United Healthcare is known as one of the best healthcare payer companies in the United States for good reason. With an expansive network of providers and innovative programs for members, United Healthcare makes it easy for doctors and hospitals to provide quality care.

Their vast network includes over 1.5 million physicians and 6,200 hospitals across the country. This gives members exceptional access to care, whether they are at home or traveling for work. Providers can trust United Healthcare to give their patients flexible coverage options at fair rates.

UnitedHealthcare offers affordable health plans that allow members to see in-network doctors with lower out-of-pocket costs. Programs like UnitedHealth Wellness also help patients better manage their health with resources focused on prevention. For providers, this means patients that are more engaged in their care.

With Oxford Health Plans, United Healthcare provides flexible products to meet diverse member needs. Virtual visits let patients conveniently access care through their phone or computer. This innovation makes life easier for both patient and physician.

Optum, United’s technology division, is another advantage for providers. Optum’s data analysis and research helps doctors improve quality and efficiency. By partnering with United Healthcare, physicians get tools to deliver better individual care and strengthen the healthcare system overall.

At the end of the day, United Healthcare’s provider-focused approach means doctors can devote their energy to patient care. Their programs give physicians useful support to better serve members. For these reasons, United Healthcare is regarded nationwide as a leading health payer that providers can trust.

Click Here To Get Credentialed with United Healthcare

3⃣ Elevance Health

Elevance Health is a top-tier healthcare payer for providers across the United States. With a presence in 14 states, it offers access to millions of members through renowned affiliates like Blue Cross Blue Shield and WellPoint. This extensive reach and strong reputation make Elevance Health a reliable partner for providers seeking growth and stability.

What draws providers to Elevance Health are the variety of coverage plans, timely reimbursements, and supportive partnerships. Medicaid, Medicare, and commercial options give providers access to diverse patient populations and needs. Prompt payment for services maintains robust cash flow. Resources, training, and tools help deliver quality care and ease administrative duties.

Elevance Health also focuses on improving patient outcomes. This aligns with providers’ goals of offering excellent care. Through investments in programs and technologies, Elevance Health assists providers in upholding stringent care standards.

In 2021, Elevance Health covered nearly 6 million members and earned over $43 billion in premiums. By the end of 2022, its membership had surged to nearly 46 million, solidifying its position as one of the leading payers in the industry. As of September 30, 2024, Elevance Health is providing coverage to approximately 45.8 million members, continuing its impressive growth and market presence.

For providers seeking reliable volume, administrative relief, and shared objectives, Elevance Health is an ideal payer partner. With comprehensive plans, expanding membership, and a dedication to service quality, Elevance Health offers robust support for providers across diverse specialties and care settings. Its national presence and locally-focused affiliates give providers the best of breadth and depth in a single payer relationship.

Click Here To Get Credentialed with Elevance Health

4⃣ Oscar Health

Oscar Health is known for its low claim denial rate—just 7%! This means healthcare providers can count on getting paid quickly and fairly for their services. Doctors, hospitals, and clinics can trust Oscar to reimburse them promptly, which is a huge relief in an age when denied claims and delayed payments are common.

Joining Oscar Health is easy, too. The provider credentialing process is simple and smooth. Once you’re in the network, you can focus on what you do best—caring for patients—without worrying about payment issues. This makes it easier for you to spend less time on paperwork and more time helping people heal.

Oscar Health values strong relationships with its providers. They only partner with the best to give their 1.65 million members top-quality care. This shared focus on providing excellent care makes Oscar Health a great partner for healthcare professionals.

Oscar Health is a leader in offering accessible, high-quality insurance nationwide. But what really sets them apart is their streamlined processes and timely reimbursements. Doctors can confidently join Oscar’s network, treat their patients, and receive prompt payment for their services.

If you’re looking for a supportive payer partner, Oscar Health is a smart choice for healthcare providers!

Click Here To Get Credentialed with Oscar Health

5⃣ HCSC (Health Care Service Corporation)

When it comes to healthcare payers, providers need partners they can rely on. Partners with comprehensive networks, efficient claims processing, and timely reimbursements. Partners that make it easy to deliver quality care. In the vast healthcare insurance landscape, one payer stands out—HCSC.

As a licensee of the Blue Cross Blue Shield Association, HCSC offers providers access to an extensive member base across 5 states. Over 20 million lives are covered, opening doors to grow practices. This gives providers a wealth of resources to enhance patient care.

Processing power matters as well. HCSC is lauded for its smooth claims handling and quick payments. Fewer administrative headaches mean more time for what matters—patients. Strong finances also offer stability healthcare providers can count on.

When choosing payers to work with, providers need more than claims paid. They need responsive partners invested in better care. With its robust network, operations, and support, HCSC checks all the boxes. For providers looking for security, efficiency, and collaboration, HCSC is a payer that truly understands their needs.

Click Here To Get Credentialed with HCSC

How to Select the Best Healthcare Payer for Your Medical Practice?

Choosing the right healthcare payers is crucial for healthcare providers. It impacts everything from financial stability to the quality of care provided. Below are some key factors to consider when selecting the best healthcare payers for your practice:

Payer Mix Optimization

Understand Your Patient Population ➜ Look at the health needs of your patients. Identify the main health challenges they face and choose payers who specialize in covering those needs. A payer with a history of effectively managing specific conditions is key.

Diversify Your Payer Mix ➜ It’s important to have a balanced mix of payers—insurance companies, government programs (like Medicare and Medicaid), and self-pay options. This balance helps reduce financial risk and ensures a steady flow of revenue.

Payment Timeliness & Financial Stability

Payment History ➜ Make sure the payer has a good track record of making timely and accurate payments. Quick payments help maintain a consistent cash flow and keep your practice running smoothly.

Understand Reimbursement Rates ➜ Review the reimbursement rates offered by different payers. Ensure that the rates are fair and cover the costs of the services you provide, so you’re not underpaid.

Quality of Care & Patient Outcomes

Commitment to Quality ➜ Partner with payers that support quality care. This includes programs for preventive care, chronic disease management, and patient education. Payers who focus on patient health outcomes are valuable long-term partners.

Patient Satisfaction ➜ Check patient satisfaction ratings and reviews. Providers should partner with payers known for high levels of patient satisfaction. Happy patients are more likely to stay and recommend your services.

Administrative Support & Technology

Administrative Support ➜ Evaluate the payer’s administrative support in terms of claims processing, billing assistance, and customer service. A payer with strong support will reduce the administrative burden on your practice.

Leveraging Technology ➜ Look for payers that offer advanced technology solutions, like EHR integration, data analytics, and tools for managing population health. These technologies improve efficiency and patient care, making your practice more effective.

Contract Terms & Bargaining

Contract Review ➜ Carefully review contract terms, especially around payments, dispute resolution, and termination clauses. Ensure everything is clear and favorable to your practice.

Negotiation ➜ Don’t hesitate to negotiate better rates, payment schedules, and other terms. A well-negotiated contract will secure better financial health for your practice and avoid potential issues later on.

Regulatory Compliance & Risk Management

Compliance Check ➜ Ensure the payer is compliant with healthcare regulations like the Affordable Care Act, HIPAA, and other state or federal requirements. Compliance is essential to protect your practice from legal issues.

Risk Management ➜ Look into the payer’s risk management strategies. A good payer will have systems in place for handling disputes, preventing fraud, and managing any financial risks that could affect your practice.

Therapist insurance reimbursement is essential for timely payment, but it only happens if you meet all the requirements and regulations set by the insurance companies.

First, you should know that insurance payers only pay those healthcare providers who are credentialed with them and only for the care services provided to in-network patients having coverage benefits of that specific care service.

It is also essential for you to check whether the insurance company covers the patient’s therapy expenses because many insurers do not offer insurance coverage for mental health services.

Furthermore, getting paid is easy, but getting instant reimbursement depends on your network of insurance providers. Some insurance companies process insurance claims for therapists and pay healthcare providers instantly, while some take time. So, it would help if you always researched when credentialing with any insurance provider. However, it is on your end to submit insurance claims with no error to speed up the mental health claims process, get reimbursed without any delay, and avoid claim rejection or denials.

To avoid errors, you should familiarize yourself with the therapy billing codes and therapist fee schedules that are essential for proper billing.

Additionally, knowing the insurance provider reimbursement rates will help you understand how much you should expect for each service.

You also need to be aware of the copayments for therapy sessions as they are typically part of the overall insurance payment for therapy services.

It’s important to understand insurance authorization for therapy, especially if you are submitting claims for therapy services. If you are working out-of-network, payment may be slower, and the rates might differ from in-network therapy reimbursement. Make sure you have clear insurance provider contracts for therapists to ensure accurate and fair compensation for your services.

Finally, understanding therapist payment policies and engaging in insurance negotiation for therapists will help ensure that your services are compensated fairly. Always review the EOB (Explanation of Benefits) for therapists to understand how your claims are processed and what adjustments may need to be made for payment.

How Do Therapists Get Reimbursed by Insurers?

After providing therapy services to patients, therapists are either paid by patients or insurance providers, and sometimes by both. To get paid by insurance providers, you must be part of a particular insurance panel. Each insurance company facilitates therapists with various insurance panels. Some of the top insurance panels for therapists are Blue Cross Blue Shield (BCBS), Aetna, Cigna, and Medicare. The process of joining a panel is referred to as credentialing or paneling.

After getting on any of the insurance panels, you are now eligible to receive payments from insurance providers for the services you provide to covered patients. In simple words, a covered patient comes to see you for therapy services: you provide care services, prepare a bill, and submit an insurance claim for therapists to their health insurer, and the insurer reimburses you.

Getting on the panel is compulsory to get paid by insurance providers. But, being credentialed with insurers also brings some drawbacks. Here, we discuss both the benefits and disadvantages of paneling with insurers.

Benefits of Joining an Insurance Panel for Therapists

Benefits of becoming part of insurance panels include:

Referrals

As a therapist, you can get referrals from your insurance providers after getting on a panel with them. This can help you grow your practice while caring for more therapy patients and receiving insurance payment for therapy services.

Wider Reach

Getting on a panel enables you to access many patients who might need help to afford therapy care expenses if they were receiving it as out-of-network therapy payment. Being part of insurance panels allows you to receive timely reimbursement from insurance providers for services rendered.

Reputation

Being in-network with an insurance panel helps you grow your reputation as a reliable and trustworthy therapist, and also helps ensure that insurance reimbursement is more consistent and predictable.

Drawbacks of Joining an Insurance Panel for Therapists

According to the California Health Report, 42% of therapists don’t accept insurance. Here are the reasons why:

Delays

The therapist credentialing process may take two to four months. During that duration, a therapist may not be able to provide therapy services to covered patients and thus may experience delays in receiving insurance reimbursement.

Administrative Duties

Insurance providers have various billing requirements. Claim filing may take a little more time for you to fulfill all their conditions. Additionally, opting for automated software or an insurance clearing house may add extra costs for processing insurance claims. Therefore, many therapists only accept insured patients to ensure payment for their services is consistent and timely.

Now, the next step is to get credentialed with insurance providers to get reimbursed by them. Here are some valuable tips for you to get on panels with insurance providers.

How to Choose an Insurance Provider as a Therapist in the USA?

There are many insurance providers.

Each has different reimbursement rates as per therapy session or per visit, as well as other requirements, restrictions, and guidelines for billing and payment.

It would help if you chose the most suitable providers whose rates are closer to your charge amount and who willingly accept providers at their panels. Asking your peer therapists can help you make the perfect decision when choosing an insurance provider. Inquire them about their experiences while working with an insurer you will be credentialed with.

Here are some factors to consider when you’re checking out different providers.

➜ Faster Payments, Reliability, and Reimbursement Rates

Before joining the panel of any insurance provider, consider the following:

• How quickly do they typically pay a therapist after a claim is submitted?
• How reliable are they? Do you know of any therapists facing difficulties when getting reimbursed by this particular provider?
• What reimbursement rates do they offer? Are the rates close to your charges, and higher than those of other providers?

These factors can positively influence your decision when joining an insurance panel.

➜ Marketing and Referral Services

Choose insurance panels that can help market your therapy services or provide additional marketing support. Also, look for those that offer referrals.

➜ Accessibility and Support

Join panels with insurance providers who are easily accessible and offer support when you need to discuss something.

➜ Gather All the Information

Before joining any therapist insurance panel, gather the following information to streamline the credentialing process:

• Your license information
• Your NPI number
• A copy of your resume
• Professional liability insurance
• Paperwork for any advanced training you have received
• Complete CAQH application

➜ Follow Up

After submitting your application, contact the insurance provider to ensure they have received everything. Some providers may require a specific processing time. However, you should follow up after three or four weeks.

How Do You Bill and Get Paid by Insurance Providers?

Once you become part of an insurance network, you can submit bills and receive reimbursement for the services you provide to patients covered by that provider. However, you must learn how to bill insurers for healthcare services rendered. Many therapists prefer outsourcing the claims submission process to third-party medical billing companies, but you can also handle it yourself, though it may be time-consuming and challenging.

You can manually submit a claim via email using the CMS-1500 form, a standard claim form for medical and mental health services.

Alternatively, insurance providers often allow you to submit claims through their online portal. When using the online portal, you follow the prompts on the screen, and the system automatically fills out the CMS-1500 form for you.

Before completing the CMS-1500 form, gather the following patient information:

• Patient’s full name
• Date of birth and SSN (if required)
• Policyholder ID
• The main insured person on the plan (if the client is a dependent)
• Date and place services were provided (in-office or online)
• ICD-10 codes
• Service code and modifier for each service provided
• Your NPI
• Your practice’s tax ID
• Your practice’s NPI (if different from your own)
• Your practice’s address

Claims can sometimes be rejected, denied, or clawed back by insurance providers due to errors. Claims are rejected when a mistake is detected before processing. They are denied when the insurance provider processes the claim and refuses reimbursement due to major issues, such as duplicate billing, invalid medical necessity, or patient ineligibility.

Occasionally, insurance providers reimburse therapists but later determine that the payment was invalid and ask the therapist to return the funds, a process known as a claim “clawback“.

Therefore, always double-check bills for errors and omissions before submission, as even a minor mistake can delay your reimbursement. Make sure the claim is completely error-free.

Finally, submit the claim either online or by mailing the CMS-1500 form. By following these steps, you can easily bill and get reimbursed by insurance providers.

Conclusion

For therapists, getting reimbursed by insurance providers is relatively easy if claims are submitted promptly, without errors, and in accordance with payer requirements and HIPAA regulations. However, it can become more complicated, as it often requires specific skills and expertise that an in-house team may lack. Therefore, outsourcing to a third-party medical billing company can be a game-changer, helping therapists receive timely payments from insurance providers.