As of May 1st 2012, our office will be out of the Aetna HMP/PPO networks

  • Share:
  • facebook
  • linkedin
  • twitter
As of May 1st 2012, our office will be out of the Aetna HMP/PPO networks Our practice unfortunately has been forced to reevaluate its relationship with Aetna health plans. At the beginning of the year, we received a letter informing us about simpler paperwork and that all their plans will now be managed through Triad, their third party administrator who previously managed the HMO networks. We never like to receive these letters because all too often, it means that the changes favor the profitability of the insurance company, while sacrificing the patients care while harming healthcare provider through more paperwork, stress and reductions in reimbursement. We have been in Aetna since the 1990's. For those of you who have had to deal with the whims of Triad and their management in the past, it has been a mixed experience with medical necessity denials, shortened treatment plans below what is medically necessary and denials of service for services other carriers routinely pay us for, since these services improve your treatment results. In the interest of maintaining quality, we have never curtailed treatment, even though they never authorized the services or paid us for them, since this would ultimately compromise our results and the quality of your experience. It was our reputation and your results and experience with our office that mattered. A few days ago, a packet arrived from Triad outlining their plans after May 1st. The changes now roll the HMO and the PPO plans under this new program. Since PPO plans are supposed to be non-gated (a more expensive plan that allows you to visit a more deluxe network of doctors without needing a referral or other type of permission to do so), those with 20 yearly visits that were used as they wanted to will now find that after 10 visits, their doctor will need to certify them and maybe they will get covered. In other words, you paid more for coverage and receive less care because of roadblocks the insurer has set up. Is that ethical? HMO members will likely see no difference since their plan was already gated. I see more paperwork for the doctor, more denials of medically necessary care and a huge drop in reimbursement levels for your chiropractor (that have been lowered twice already over the past few years, which created financial hardships for our practice and my family) while the cost of living and running the practice continues to increase over time. Like many of you, we have worked harder and more hours just to keep up. This is in contrast to insurance companies seeing fewer services billed to them because as patients have had more cost sharing, many have put off often needed services (The NY Times reported on this) during this recession. I personally have difficulty with their position especially since over the past three years, Aetna and other insurance companies have raised insurance rates mercilessly while we paid more to insure ourselves and our families and they squeezed healthcare providers by paying them less. Where is the money going if it is not paying for medical services? This, in combination with our office seeing fewer and fewer Aetna patients is forcing us to reevaluate our in network relationship with all Aetna plans, since we do not believe they value the results we achieve in our offices as per this newest policy change. I suspect many other experienced chiropractic physicians are considering leaving as well, especially those that are well established and are most experienced. Aetna's track record, which has been in our opinion again singles out chiropractic (it is not the first time), decreasing the payment value for manipulation, the chiropractic specialty is unacceptable at best, unethical at worst and hints of remnants of the Wilk suit, which was brought against the AMA for trying to contain and eliminate the chiropractic profession. If anything, it would be appropriate for them to recognize the results we achieve as a profession and increase our level of reimbursement, since the cost of running a business such as this continues to increase, rather than decrease. I apologize to all who may be affected; however, we will continue to accept Aetna on an out of network basis after May 1st, 2012. Some of you may find this works out better. If Aetna reconsiders their position, we may reconsider ours. We continue our other relationships with United Healthcare, Horizon Blue Cross Blue Shield, Qualcare, Oxford, Medicare and other payers. Again, I apologize for any inconvenience this may cause and it is my hope you stay a practice member based on our quality of care, the value we offer and our practice outcomes. We continue to maintain ourselves as the gold standard in the communities we serve.