Dear Valued Customer & Friends;

I have been put in the unfortunate position to have to withdraw from the Kaiser-referred and self-referred panel. It is with a heavy heart that I write this letter, but once again, I’ve been placed in a position where I have to make the best financial decision for the clinic.

What does this mean to you? 

Kaiser does not have out-of-network benefits. This means you will need to find a new or different provider who accepts these benefits.  

What happened/Why now?

Over the past six years, the insurance industry has gone through sweeping changes. These changes were problematic, but I was hoping Kaiser, being such a large provider, would act with fairness and move, like the other insurance providers, to rates that, at least, matched Medicare rates. 

This has not happened. Kaiser has 2 acupuncture benefits: referred and self-referral. The referred benefit pays 2/3rds of Medicare rates in Cowlitz County. The self-referred pays about 1/3rd Medicare rates. Kaiser will rarely refer patients. If they do refer patients, you have to verify if the deductible has to be covered first. With referred benefit, the deductible usually has to be covered first. So, the member is stuck paying for the full cost of their acupuncture visit anyway. 

Kaiser Reimbursement

Kaiser self-referred pays a flat fee of $52** a visit (about 1/3rd of Medicare rates). 95% of the patients in 2023 are required to use self-referral. What makes this more frustrating is starting in 2020, most Kaiser patients have a co-pay of $40 to $50 dollars. So, Kaiser pays about $2-$12 per acupuncture visit. The patient pays $40-$50, and the provider kicks in $90-$100. The Kaiser CEO salary in 2013 was 4.3 million. Over the last 10 years that salary has quadrupled to over $16,000,000/year (Yes, over $16 Million Dollars).

High Administration and Lack of Following Current AMA Guidelines

The insurance industry calls providers in their network as “on panel.” To remain on panel with Kaiser takes an enormous amount of energy. Kaiser’s paneling requirements are unique and place a heavy administrative load on small providers like myself. Each renewal requires an excessive amount of effort. Delivering all the documents Kaiser requires will take one to two weeks. They will audit and re-audit which can take a month or longer and even more of my time to try and appease them. They will include requirements that go above AMA or business legal requirements. Their requirements change every time so there is no chance you would ever pass their audits. Kaiser is the only insurance provider who does this type of micro-management administration.

They have become an administrative nightmare for me as a provider. Besides reimbursing at a significantly lower rate than Medicare, they will deny charges that Medicare and the AMA consider appropriate. 

How You Can Help

I was hoping our State Representatives would help. A bill had gone up to our State Representatives in 2023 to address the disparity in pay from some insurance companies. This bill did not make it out of committee.

One of the largest clients of Kaiser in the State of Washington is our public schools. I pay taxes in this state. My taxes are how our Public Schools pay Kaiser. We went through a considerable pay reconsideration as teachers were paid disproportionately. I supported those efforts. If you are part of our public school systems, I would reach out to you to talk to your Public School representatives and request that they support a living wage for all by refusing to use insurance carriers who take advantage of their providers and members or by choosing another insurance option than Kaiser. 

Sincerely,

Kim Blaufus

Notes:

** This rate has not changed since the 1980’s. In that same time, inflation has increased almost 300%.

** If you were working for an employer, the $52 would come out to about a salary of $72K a year (about 30% of every hour I work is administration). When you work for yourself, you do not have vacation or sick time. You just lose that time. You have to pay your own health insurance and the employer part of payroll taxes and social security (another 8%). As a business owner, you will have to pay for employees which consumes over half of what Kaiser pays. That is before all the expenses of running a business. Each Kaiser patient is seen at a loss. Kaiser pays their providers less than the poverty line, and the current State government supports that. 

Here is one of the documents used to obtain 2013 CEO salary.