The company plans to alert members and their physicians if they are leaving the insurer’s network for care. Once the member is alerted, the company will work with them to shift the referral to an in-network provider. Aetna says the aim is to alert members who may not know that an out-of-network referral could cost them more money. Aetna says shifting the care to in-network providers provides an average savings of $5,000 per incident.
The program depends on a precertification process that requires physicians to notify the insurer when they make an out-of-network referral to a freestanding ambulatory surgery center.
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