10 February, 2025: Aetna reverses proposed reimbursement policy for nurse practitioners and midwives.
Aetna had announced a policy change to reimburse nurse practitioners who have physician oversight and nurse midwives at 85% of the allowed amount. On February 10th they chose to reverse this change, apologizing for the confusion.
The article also states: “While nonphysician practitioners who bill directly under their own name and National Provider Identifier will still receive payment at the reduced 85% rate, the reversal means that those who bill “incident-to” a supervising physician will receive full reimbursement.”. This brings up an interesting question. Why do nurse practitioners get reimbursed at a lower rate if they are independent of physician oversight? They are providing the very same care, whether or not they have a physician overseer or not. This has no bearing on the quality of care they provide, as shown by the robust amount of quality, peer reviewed research over the last 50+ years.
By reducing reimbursement for nurse practitioners, the ability to provide care is also limited. There is no difference between a practice run by a physician and one run by a nurse practitioner. Limiting reimbursement based on licensure makes it tougher for nurse practitioners to open a practice and remain in business. This limits access to care for residents of the state.
You can help change this! Call your legislators at both the state and national level and let them know your frustration with the insurance system, and how it restricts your ability to receive timely quality care. Let them know that you want nurse practitioners to be able to practice as fully as physicians and be reimbursed at the same rate as physicians. This is the only way to expand access to quality care!
