Compare

Four ways to handle denials. An honest comparison.

Every option below works for some teams. Here is how they differ, and when each one is the right choice.

Four ways to handle behavioral health denials
	In-house billing team	Offshore A/R vendor	Billing software alone	Sky Gathering RCM
Behavioral health depth	Depends on who you hire	Varies; many focus on general medical billing	Rules and edits, no clinical writing	Facility BH only: detox, residential, PHP, IOP
Medical necessity appeals	If staff have clinical writing skill	Varies; often template-based	Not included	Drafted from the chart, specialist approved
Cost model	Salaries and benefits	Hourly or per claim	Subscription	Audit fixed fee; recovery on contingency
Capacity	Fixed headcount	Scales with hours bought	Scales, but someone still works the queue	Agents triage and draft; specialists decide
Patient data	Stays in-house	Shared with the vendor under contract	In the vendor's cloud	BAA first; Part 2 agreement for SUD; minimum necessary
Portal access	Staff log in	Varies by vendor	Varies	Official connections only; no portal bots

When each one is the right choice

In-house team
Right when you have steady volume, a strong lead biller and time to train clinical appeal writing.
Offshore A/R vendor
Right for high-volume, low-complexity follow-up where cost per touch matters most.
Billing software alone
Right when your denials are mostly front-end errors and your team has time to work the queue it surfaces.
Sky Gathering RCM
Right when denials are clinical and complex, aged A/R is piling up, and you want to pay for recovered dollars rather than hours.

General descriptions of each option, not reviews of any specific company. Many teams combine more than one.

Next step

Twenty minutes. No patient data needed.