Insurance Reimbursement Woes

August 28, 2010

There’s been a lot of discussion amongst my colleagues about insurance reimbursement for our services.  The consensus is that we are not happy with about half of the companies’ fee schedules for reimbursement. ND’s are reimbursed sometimes only 1/3rd of what an MD would be reimbursed for the same visit, AND we spend more time and answer  more questions for the patient.  We have more education than an ARNP, yet are sometimes only reimbursed 1/2 of their reimbursement.  So, ultimately, we are getting paid less to do more.

As we are considered a primary care provider in Washington and many other states, it seems only right that we are reimbursed equally to other primary care providers. This issue is forcing us as a profession to consider dropping our contracts with numerous insurance companies.  This is not beneficial to our patients, so it is a very hard decision, but ultimately, if our reimbursement is so poor, we will eventually be forced to close our doors.  Obviously that does not benefit our patients either.

If you as a patient feel strongly about this and would like to help change the ways of the insurance companies, here’s what you can do.  Talk to your employer or insurance broker about the possibility of switching your insurance carrier.  At this point, the best reimbursement rates for us are from Uniform and Regence.  Next best choices are Premera, Lifewise, and Group Health. Please note that Group Health does have more limitations for coverage of preventative care, however.  The worst reimbursement rates come from Aetna, United, and Cigna.  Cigna has the very lowest of rates and they are also difficult to work with.  Please consider changing from Cigna to another carrier if you are able.

It may eventually take a large movement from not only providers, but also patients, to make changes in our insurance system. However, I do believe that small steps from each of us can help set the right course.

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