You're getting squeezed and want ideas.... The recession has eroded health insurers' profits; they then lower practitioner reimbursement. Layoffs mean fewer enrollees in company-sponsored plans and less premium revenue for insurers. Reimbursement for E&M services declined by 7.3% on average; 99213, the bellwether CPT Code, fell to $65.49.  E&M reimbursement for private payers declined, esp. in the Mid-Atlantic region, however it improved in Medicare.