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Pediatricians are being left behind as costs increase and commercial insurance reimbursement rates fall

Patient Access Weekly Advisor, PR Newswire via Yahoo, August 29, 2007

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Commercial insurance reimbursements for physician office visits have barely changed since 2001, causing rates that are increasingly lower than Medicare's, according to data compiled from practice records by Allied Pediatrics of New York, PLLC.

While Medicare reimburses physicians almost 15 percent more than it did in 2001 for the more complex office visit (from $92 in 2001, to $105 today), the commercial insurance reimbursement for the same code during this period has actually fallen 1.5 percent, from $65 to $64.

Pediatricians are especially impacted by this trend because they rely entirely on commercial insurers to provide compensation for the general office visits that constitute the bulk of their practices. A clear example of the challenges pediatricians have today can be seen in the inadequate reimbursement for the administration of childhood vaccinations. Private insurers do not always begin to pay for improved vaccines as they become available. Furthermore, the rate at which commercial insurers reimburse does not always meet the actual cost of the vaccine, causing pediatricians to accept a loss in order to provide the best care.

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