A Contemporary Look at Third Party Reimbursement for Health Education

For more than 30 years, there has been substantial discussion within the health education profession on the need to seek third party reimbursement for the services of trained health educators. Third party reimbursement has been viewed as one legitimizing strategy for health education. Research shows that health education is a reimbursable medical expense. However, to be reimbursed the patient must be under a doctor's care and health education is part of a treatment plan. Diabetes is one area where some patient health educators have been reimbursed as part of a health care team. Yet the opportunities to sit for the national diabetes educator certification exam and other national diabetes guidelines have heretofore excluded both certified and non-certified health education specialists. Recent efforts by SOPHE and other groups have re-opened conversations around such policies. Moreover, the role of “wellness coaches” in innovative pre-diabetes prevention programs is being financially supported by CDC and United Healthcare. This presentation will address the questions related to health education as a reimbursable health expense; current developments in diabetes and other areas where third party reimbursement is being pursued; and questions and challenges related to pursuing third party reimbursement as a national long-term strategy for helping to “legitimize” the health education profession.