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Wednesday, November 6, 2019

Reimbursement Rates in Nevada

The Politics of Autism includes an extensive discussion of insurance and explains the limits of insurance mandates.

Mark Hernandez at The Nevada Independent:
Changes in Anthem Blue Cross reimbursement rates could put intensive treatment out of reach for scores of Nevada children.
Starting in 2020, reimbursement rates that Anthem would pay to medical providers for autism-related services were supposed to be lowered to the same rate as Medicaid, which is less than the national average and which advocates have long said is woefully low. Anthem changed course a few weeks later, saying the first rates were a mistake, yet some medical providers are already looking towards other insurance companies to do business with.

“Since 2015, Anthem has continually reduced their rates by approximately 60 percent which has become cost-prohibitive for us to remain in-network with them,” said Jon Paul Saunders, clinic director of the Las Vegas-based Lovaas Center, which focuses on autism treatment. “In Anthem’s attempts to align with Medicaid rates, they have lost us as a participating provider.”
As one of the major medical insurance providers in Nevada, the dispute over Anthem Blue Cross and Blue Shield’s rates could limit which doctors are available for autism-related services. There are currently 60 children who are covered by the insurer that receive treatment from the Lovaas Center, and they may have to pay out of pocket to continue with the provider or seek help elsewhere.
A spokesperson for Anthem Blue Cross responded to a request for comment from The Nevada Independent by saying that the latest rates are the same or higher than existing levels.