A Better Understanding of the Insurance Reimbursement Struggle

At Cornerstone Prosthetics & Orthotics, we aim to keep our community informed about crucial issues affecting the quality and accessibility of care. Today, we're reluctantly addressing a challenge impacting our clinic and the patients we serve: the outdated pay scale insurance providers use to reimburse orthotics clinics. We've been negotiating behind the scenes for months, doing our best to advocate for our patients.

Here's an update.

The Insurance Dilemma

UnitedHealthcare (UHC), a significant insurance provider, has used an outdated reimbursement model based on a 2012 Medicare fee schedule for years. Unfortunately, there have been no rate adjustments for over eight years. UHC's reimbursement rates are only about 40-50% of the 2024 Medicare fee schedules. This rate disparity is widening annually, creating significant hurdles for clinics like ours to deliver quality care.

The Impact on Care

At Cornerstone Prosthetic and Orthotics, we serve many patients who rely on our services to, at a bare minimum, maintain their quality of life. However, due to the drop in reimbursement rates, we face a financial strain that could force us to offer limited services to UHC-insured patients. This issue is not just about numbers; it's about people who depend on us to access essential care. Prosthetic and orthotic services account for less than 1% of UHC's healthcare spending. Therefore, adjusting reimbursement rates to align with current Medicare standards would be a modest change that could substantially improve patient care and accessibility.

A Call for Change

For years, providers in Washington state have been striving to renegotiate fair contracts with UHC. Unfortunately, these efforts have been met with resistance. Instead of meaningful negotiations, UHC has offered contract termination as the sole alternative, which feels like economic bullying against smaller healthcare providers. This situation underscores a significant access-to-care issue that our patients are starting to feel directly.

While it seems easier to terminate the contract with UHC, our patients would suffer. Ultimately, we may still be forced to terminate the contract, but it is our last resort. At this time, Cornerstone is focused on patients' well-being, and we will continue to urge UHC to consider the consequence of counseling smaller healthcare providers to terminate the contract instead of negotiating fair reimbursement rates.

Our Request

We encourage patients insured by UnitedHealthcare to contact them and request a reassessment of their reimbursement rates for prosthetic and orthotic providers. UHC members can receive the essential care they deserve by increasing reimbursements to match 100% of current Medicare rates.

To take further action, UHC-insured patients can call the Insurance Consumer Hotline at (800) 562-6900 or file a complaint using this link: File an insurance complaint.

We remain committed to serving our community and advocating for the necessary changes that will allow us to continue providing quality care. Your awareness and support can make a difference in helping us navigate these challenging times. Thank you for taking the time to understand what's happening behind the scenes at Cornerstone Prosthetic and Orthotics. With the patients we serve, the companies who insure them, and the clinics providing care, we can work toward a solution that benefits everyone involved.