Good news for our Aetna patients under the PPO and some HMO policies
After many problems that began when Triad healthcare had earned the contract with Aetna PPO and their new contract which began last year, Aetna has decided to no longer use Triad to precertify their PPO plans as well as other plans.
The problems were caused when Triad attempted to capture many of Aetna’s plans and manage them. The new contract added paperwork, precertification and oversight to doctors was well as a marked fee reduction. This went over poorly, especially since patients who required x -rays that should have been covered were no longer covered, even though their plans actually allowed for payment of this service. Other problems including the fact many doctors refused to sign the addendum allowing Triad to manage their PPO clients. Doctors who refused to sign the addendum such as our office were told they would be removed from the network.
The truth is that doctors who signed the addendum were paid less, not paid properly and had many problems. Doctors who did not sign this document never saw a reduction, or any other issues with their reimbursement other than some minor misunderstandings when the Triad plan took affect last April.
Our office maintains very high quality protocols for treatment of our patients and helping them with their problems. We will only take on plans that treat both the patient and the provider fairly. The rare exception is the Aetna HMO which still has Triads reduced fees and protocols however, we decided not to withdraw from Triad since many of our patients rely on us and they are in the Aetna HMO.
Going forward, we will continue our tenuous relationship with the Aetna networks. It is my opinion that Aetna should take over all plans and eliminate the need to deal with Triad however, this is not my decision. Perhaps, Aetna management will look toward more patient and chiropractic friendly policies in the future.