Almost all private insurance companies cover medical and surgical services provided by PAs. However, with scores of different payers and plans, including preferred provider organizations (PPOs) and health maintenance organizations (HMOs) providing coverage in the United States, there may be differences both in how services delivered by PAs are covered and how claim forms should be filled out.
Even within the same insurance company, PA coverage policies can change based on the particular plan type or the specific type of service being provided.
Some companies require that the service provided by PAs be billed under the name of the supervising physician. Others ask that claims be submitted with the name of the PA. Although many private payers do not separately credential PAs or issue provider numbers, PAs are generally covered for most services they provide.
When plans do not credential or issue provider numbers to PAs, they typically want the service billed under the name of the supervising physician, occasionally with a modifier code attached. It is critically important that one not assume a policy for billing for PAs. Get specific information from a reliable source within the insurer. As mergers and acquisitions continue to consolidate the health care marketplace, coverage policies for PAs are becoming much more consistent among payers throughout the country.
For more detailed information, visit the Private Insurance Companies document in the Resources section.
View profiles with detailed information on private insurance companies in your state.
