New Jersey ASC Association Asks State to Investigate Aetna's In-Network Redirection
NJAASC previously sent a letter to Aetna asking them for clarification on this matter. Aetna legal counsel spoke with NJAASC legal counsel Brach Eichler and said the company would respond with answers. To date, it has not done so.
The NJAASC wrote to the state to address the Aetna's practice of sending letters to prospective patients and physicians, informing them of cheaper, in-network alternatives to the in-network facilities where procedures were originally scheduled.
"It is important to remember that there is no such thing as an in-network fee schedule that is the same for everyone — something the general public probably does not realize," said Jeff Shanton, NJAASC representative. "Individual healthcare providers negotiate separately with Aetna, and indeed, all commercial carriers."
This discrepancy between contracting means that some providers have higher in-network contracted rates than others, he said. Aetna is allegedly seeking to re-direct patients away from in-network providers with more favorable rates for the patient to in-network providers with more favorable rates for the insurer.
Related Articles on Coding, Billing and Collections:
CMS Proposes 2013 Payment Rates for ASCs
10 Statistics on Payors Dropped by Physicians Since 2009
CMS Coverage for Bariatric Surgery Left Up to MACs
© Copyright ASC COMMUNICATIONS 2012. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.
- 7 Guidelines for Preparing a News Release About Surgery Center Accreditation
- Hiring Physicians: 6 Questions Providing Insight Into Candidates
- Physicians: Timeline for 2014 Deadlines to Remember
- Spotlight on MMX Healthcare: Developing Reliable, Affordable Tools for ASC Data Tracking & Management
- Hand Hygiene Story Roundup