New Jersey ASC Association Asks State to Investigate Aetna's In-Network Redirection

The New Jersey Association of Ambulatory Surgery Centers has sent a letter to the New Jersey Department of Banking and Insurance, asking them to investigate Aetna's practice of redirecting in-network patients.

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.

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