Declining reimbursement

[Attending1985]

Management at my hospital system has communicated that reimbursements are declining. I knew that Medicare was paying less but they also said commercial insurance reimbursements are also declining. Is this true?

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[randomdoc1]

no. it's not. Aetna did an increase and so did blue cross in my geographic area. Medicaid also increased their rates. Medicare did decrease but only about 1-2%. I'd be very suspicious of this. Even as a family owned practice, I've negotiated increases year over year. With United/Optum in the four years I worked with them, I got them to more than double the rates they've paid us (even got them to out pay Blue Cross which United at first said they "can't" do). That and we found other insurances to work with that pay more than 150% of the going Blue Cross rate here. A larger system should have way more negotiating power than me. Something is not right on their end.

 

[randomdoc1]

I've heard in my state my colleagues being told this same crap you're sharing by the hospital systems they work in. I don't believe it because my practice is seeing the opposite. Something is very wrong on the employer end. Either they are keeping the money or they are doing a really atrocious job of keeping their rates updated or they have horrendous financial management or some combination of those three.

 

[splik]

Management at my hospital system has communicated that reimbursements are declining. I knew that Medicare was paying less but they also said commercial insurance reimbursements are also declining. Is this true?

Hospitals negotiate their own reimbursement it’s highly individualized. They get what they negotiate with the insurance plans and usually have a whole army of lawyers to negotiate rates. In my area the hospitals are all big systems and they will threaten to leave the insurance if they don’t get the rates they want which is usually over 1000 for 99205 and over 500 for 99214 to give you an idea. If the hospital is truly experiencing declining reimbursement that should only be relevant to you if you are on an EWYK system which hospitals almost never have. This is probably just a ploy to minimize costs.

ETA they are also legally required to publish the rates they get from insurance by plan so you should be able to look this up

 

[Sushirolls]

A blue at my old location sent out letters saying they were cutting their reimbursement. And this was the only that historically was increasing rates.

Aetna hasn't changed for me. None of them have gone up.

 

[vanfanal]

Hospitals negotiate their own reimbursement it’s highly individualized. They get what they negotiate with the insurance plans and usually have a whole army of lawyers to negotiate rates. In my area the hospitals are all big systems and they will threaten to leave the insurance if they don’t get the rates they want which is usually over 1000 for 99205 and over 500 for 99214 to give you an idea. If the hospital is truly experiencing declining reimbursement that should only be relevant to you if you are on an EWYK system which hospitals almost never have. This is probably just a ploy to minimize costs.

ETA they are also legally required to publish the rates they get from insurance by plan so you should be able to look this up

Oh my gosh! What a rip off for docs.

 

[forchinet121]

I've heard in my state my colleagues being told this same crap you're sharing by the hospital systems they work in. I don't believe it because my practice is seeing the opposite. Something is very wrong on the employer end. Either they are keeping the money or they are doing a really atrocious job of keeping their rates updated or they have horrendous financial management or some combination of those three.

On average for private insurance how much are you getting for 99214 and 90833? Are you in a low cost of living or high cost area

 

[randomdoc1]

On average for private insurance how much are you getting for 99214 and 90833? Are you in a low cost of living or high cost area

I'm in the midwest, low cost living area. But it is the biggest city in the state. Average private insurance pays $210 for 99214+90833. We've lately gotten more referrals of members who have higher paying insurance insurance and that has been paying $300 range for 99214+90833. My favorite one pays $360 for a 99214+90833 and I'm starting a campaign to market to employers who offer this insurance.

 

[ChudsMgee]

$360 for 99214+90833...... Wow

Mine average $160 with the max being $210. I am brand new to the area though and this is my first contract with the insurers

 

[randomdoc1]

$360 for 99214+90833...... Wow

Mine average $160 with the max being $210. I am brand new to the area though and this is my first contract with the insurers

yea, the higher ends have me....

🤤​

 

[PikminOC]

A blue at my old location sent out letters saying they were cutting their reimbursement. And this was the only that historically was increasing rates.

Aetna hasn't changed for me. None of them have gone up.

And my overhead is always going up too like I'm sure it is for hospitals also.