The PAI Group and Aetna Discuss Payment Policies for Non-Participating Providers
April 17th, 2008
Aetna and the Physician Advocacy Institute (PAI) have commenced discussions regarding the new 125% of Medicare Aetna methodology utilized to determine the payments made to non-participating providers when the benefits are considered to be “in-network” under a patient’s benefit plan.
In a March 5 meeting at Aetna headquarters in Hartford, Connecticut, PAI President and NCMS EVP, CEO Robert W. Seligson, NCMS Associate General Counsel Carol Scheele and Aetna Compliance Dispute Facilitator Cameron Staples described the impact of the policy on hospital-based physicians and potential implications for physician relationships in general.
They suggested that the policy impacts not only non-participating physicians but also participating physicians, who may believe that reduced reimbursement for non-participating services will be utilized by insurers as a tool during the negotiation process. Aetna provided data indicating that these circumstances affect a relatively small proportion of Aetna’s claims.
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