Is there Insurance in Medical Insurance?

Why would athletic trainers want to move towards third party reimbursement when it isn’t even working in the traditional insurance setting?

As Dionne Middlebrooks, PT, DPT, OCS, CSCS pointed out on LinkedIn:

"Walmart is a billion-dollar corporation and they are closing ALL of their health centers.

Why?

Because they stated that reimbursement from all insurance providers has proved to be too challenging and that it is not a sustainable business model.

This is why medical providers are going out of network with insurance. Your insurance is NOT paying for your healthcare. They are taking your money and finding ways to avoid paying providers that you are seeing and if they pay, they are only paying a fraction of the true cost.

If a billion dollar corporation couldn't make the insurance business model sustainable, shouldn't that be a warning sign to healthcare providers taking insurance? Shouldn't it be a warning to patients receiving care that the 10 minute visit with you provider isn't going to get any better because your insurance isn't paying for your care to improve?"

Make note that NATA and certain state associations are making a push to get third party reimbursement that would be assisting the general membership-at-large. It will be great to have the option available, but I do not think it will help in getting ATs paid more for their services.

We have to be savvy in understanding the restrictions of using third party reimbursement in that it will dictate the direction of care if the clinician wants to qualify for the most reimbursement. Our value may diminish due to being unable to navigate new and innovative ways for treating a patient. There may be less individualized care and more cookie cutter protocols.

Reimbursement is a negotiation. A clinician will rarely receive full payout for the services rendered. If providing value based care to each patient is your mission, more resources to manage third party reimbursement may be needed. Redesigning care delivery to provide more value to patients requires new tools, competencies, and infrastructure. To that end, it is necessary that payment models be accompanied by technical assistance and infrastructure support.

Third party reimbursement or cash payments do not fit all AT settings. We should have accessibility to this type of service for compensation, but it will be interesting to watch how it is utilized and maximized with so many caveats attached to this service.

Cash is still king.

billing-reimbursement-guidance.pdf (nata.org)

Billing 101_Final_Oct2014 (nata.org)

Shelby 5/2024