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NJAASC Letter Demands Aetna Stop Patient Re-Direction Among In-Network Centers

The New Jersey Association for Ambulatory Surgery Centers has sent a letter to Aetna in response to their efforts of re-directing patients from one in-network facility to another, less costly in-network center.

"This is absolutely intolerable and shows that Aetna has decided to ratchet up the anti-ASC campaign to new levels," says Jeffrey Shanton, Chair of the Advocacy and Legislative Affairs Committee of NJAASC. "The facility where a patient elects to have his or her procedure performed is not a decision that Aetna should ultimately control or attempt to influence, especially if all the centers in question are in-network. This is consistent with accepted standards of care and professional ethics, as well as New Jersey State Law and public policy."

John Fanburg, managing member of BrachEichler, addressed NJAASC's concerns to Aetna's head of national provider contracting and demanded the company immediately cease and desist this redirection.

"Remember, this is not about out-of-network; this pits in-network versus in-network," says Mr. Shanton. "ASCs and other healthcare providers have always been led to believe that by going in-network, and accepting lower reimbursement, they would see volume increase. That has now changed. Centers that were able to negotiate in-network contracts that they believed were favorable are now caught between a rock and a hard place; do they stand pat with a higher in-network contract than a competitor and see their volume decrease or do they negotiate a lower in-network rate to try to capture volume? Either way, it is a no-win situation for them."

NJAASC invites physicians and providers to forward questionable correspondences from insurance carriers to the organization so it can take future action.

More Articles on New Jersey ASC Market:

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