The insurance company recently reached out to members and their physicians to alert policyholders when a referral for an outpatient surgical procedure takes them out of the Aetna network, creating another obstacle for out-of-network surgery centers.
According to an Aetna release, an analysis by the insurance company showed that half of members who received a referral to a surgery center did not know the referral would take them out-of-network. When those members were informed by Aetna and chose to stay in-network, the average medical bill was reduced by $5,000 per incident.
Mr. Shanton said that though he informed NJAASC membership about the issue, few centers contacted him or commented on the issue. “They blatantly try to get physicians to ‘discuss location options’ with their patients, and then send patients to a cheaper in-network facility,” he said. “And of course they remind physicians that they should ‘refer to an in-network facility whenever possible.”
He questioned the lack of indignation from NJAASC’s in-network member centers, as well as from physician owners. “Aetna is asking you to not take patients to your own surgical center, but somewhere else,” he said. “You need to make sure that your doctor/owners to know and fully understand what is going on, [as well as] the ramifications — which are monumental.”
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