NCMS Joins with Emergency Physicians to Protest Aetna Payments
November 3rd, 2007
North Carolina Medical Society (NCMS), the North Carolina College of Emergency Physicians and Wake Emergency Physicians have joined together in a letter to the North Carolina Department of Insurance (NCDOI) Commissioner Jim Long to request review of Aetna’s “Non-Participating Physician Policy.”
Aetna has announced nationwide that it will cover services of non-participating providers at 125% of the Medicare rate, leaving physicians to recover the remainder from the patient. It is also believed that Aetna is reimbursing North Carolina non-participating physicians under this policy. This is deemed unacceptable under North Carolina statutes pertaining to patient cost-sharing in emergency situations.
Furthermore, NCMS, NC-CEP and WEPPA have asked the Commissioner to express an opinion whether these physicians should be paid directly under a valid assignment of benefits, and whether these statutes and NCDOI decisions apply to both emergency department physicians and on-call specialist physicians.
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