Ask Mike - Nurse wanting to paid through clients insurance

Dear Hoping,

Thanks for writing. You are a CNA in Pennsylvania and you would your clients to pay you for your work directly through their insurance.

It appears that there are at least two barriers to your being directly paid by individuals' insurance:

1. Almost all insurance policies do not cover CNA services.
2. Even if the services were to be included in a policy, most insurance companies only make payments to agencies, medical facilities and doctors and therapists.

Public and private long term care insurance that covers in-home services typical covers home heath type services that are prescribed by a doctor and overseen by a nurse. The policies just aren't written to cover paying individual contractors again for physicians and certain licensed therapists such as psychologists and occupational/physical therapists. Typically these individuals have either set up an agency or a company to handle their business affairs including dealing with insurance.

At this point, your best bet would be to contact your state Medicaid agency and possibly a Center for Independent Living (CIL) or an Aging and Disability Resource Center (ADRC) and see if they have any information or ideas. You can contact those resources by going to the State Information section of the PAS Center Website. In the "State Information" section you will find a link to Agencies Related to PAS. Click on this link and then select your state from the map that follows. Go to the CIL or ADRC listings for contact information. When you contact them, ask them if they have any ideas. I am afraid that to overcome the barriers I noted above, there will be quite an advocacy challenge with quite possibly a need to change state insurance rules, if not federal rules, too.

Good luck.