NCMS Asks DOI to Halt Aetna Mid-Level Rate Cut

In the March 2010 edition of its provider newsletter, the Aetna Insurance Company announced that, effective June 1, it would cut reimbursement rates for covered services provided by mid-levels to 85% of current rates.  Aside from the brief announcement in the newsletter, individual physicians and practices received no additional notice or details about how the new policy would be applied. 

From the beginning, NCMS’s position has been that this unilateral “policy change” by Aetna is actually an amendment to your provider agreement with Aetna, and that Aetna must therefore follow the applicable legal requirements for proposing contract amendments.  These requirements include individual notice of the proposed change and sixty (60) days to allow you to object.  NCMS initiated a conversation with Aetna to share our concerns and request that Aetna follow the law.

Unfortunately, Aetna insisted in moving forward with the mid-level cut.  So earlier this week NCMS submitted a letter to the NC Department of Insurance, seeking their assistance and requesting that they compel Aetna to follow state law.  To read NCMS’s letter to NCDOI, click here.

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1 Comment

  • Robert Hollingsworth DHSc, PA-C

    This is an important issue for the NCMS to address and, as a physician assistant, I appreciate the energy and support that the Medical Society is applying to this problem. If Aetna does this, the other insurance companies will certainly follow. It is felt within the primary care community that with the decline of the family practice physicians, mid levels will be called upon to fill that void. It is difficult enough for a mid-level (many of us employed in solo settings) to continue to provide care to patients with the medicare reimbursment rate. Now the insurance companies want to follow suit. Those of us who work on “our own clinics” have the same overhead and financial responsibilities that our supervisors do and this 15% cut in reimbursment affects our ability to continue to practice. The additional cuts will be a real problem for us.

    Thank you for taking this issue on. We certainly need your support here.