This is a long read, but I think it's important for people to understand why it's so hard for those of us in private practice to work with insurers.
I absolutely love my newborn medicine “side gig." Being able to see babies in their own homes, forge a true relationship with my patients’ families, and be an ongoing resource for new parents is why I opened Primrose Newborn Care in 2018.
I made the decision to get credentialed to be “in-network” for local insurers in 2019 because I met many parents who wanted to use my services, but were unable to because I did not accept their health insurance. I applied to become “in-network” for several local health insurers.
Four of the six insurers who I applied to rejected my application since they already had enough pediatricians in their NE Ohio networks. The two insurers that accepted my application and credentialed me to become an “in-network” provider were Medical Mutual of Ohio and Caresource.
Since becoming “in-network” with them almost two years ago, the most I have been able to get reimbursed from either of them is $30 for an in-home newborn visit.
Although $30 might sound like plenty of money to be paid for a one-hour, in-home newborn visit, it is not sustainable for the following reasons:
Each newborn visit is not just one hour! Although my actual “face-to-face” time with my patients during each visit is one hour, there is usually an additional hour of work for each encounter (this includes travel time, documentation and charting time, coordinating lab draws, calling in prescriptions, talking to my babies’ pediatricians to transfer care, etc). And then there’s often an additional hour of post-visit communication with my patients’ parents via text messages, emails, and phone calls in subsequent weeks (which I do not charge for).
So, the $30 insurance reimbursement I get for each visit is for three hours of work. Here is where the $30 ends up going:
Of the $30 I am reimbursed from insurance, about $6 goes toward taxes = $24 left
And about $4 goes to my malpractice insurance premium = $20 left
Then about $6 goes toward gas and transportation costs (I drive up to 45 minutes to see patients) = $14 left
I have about $3 in medical equipment and technology costs for each visit (i.e. electronic health record, medical billing fees) = $11 left
I also have about $3 in licensing, certification, DEA, and continuing medical education costs (requirements to practice medicine in the State of Ohio) + lactation certification fees to be an IBCLC = $8 left
And $2 in marketing/advertising materials, brochures, business cards, etc. = $6 left
And then I give a small gift to each family = $3 left
So, as I have shown, every time I accept health insurance for an in-home visit, I end up with an income of $1 per hour after all of my expenses have been paid.
I cannot think of any other job in which making $1 per hour is reasonable or sustainable.
Please know that I can work with you in other ways to be able to afford visits, and all of the following are possible:
1. We can work on a sliding scale. In some cases I can reduce my in-home fees by up to 50% depending on families’ financial situations.
2. I can give you a "superbill" to submit to your own insurance for “out-of-network” costs – many of my patients’ families have been able to get reimbursed this way over the last few years.
3. You can submit my "superbill" to your employer-sponsored FSA or HSA – 100% of my patients’ families who have gone this route have been reimbursed.
4. We can meet via telemedicine (video). By doing this I can significantly reduce my fees.
Please let me know if you have any questions after reading this. You can call or text me at (216) 313-2016 or email at primrosenewborncare@gmail.com.
Love to all of you and here’s to a better 2021 for all of us ❤️