Is this a round about way of getting more physicians in network to cap out of network compensation? BD
Physicians in multiple states are crying foul at Aetna's declaration that it would cap the amount of reimbursement paid to out-of-network doctors at 125% of Medicare. They are also upset that Aetna informed patients through their explanation of benefits forms that they don't have to pay any bill a doctor might send to make up for costs and fees lost as a result of the insurer's cap. Organized medicine is telling Aetna its move isn't just unfair -- it's also a violation of its settlement agreement with physicians as part of a class-action lawsuit that claimed health plans conspired to underpay physicians by downcoding and bundling physician claims.
In a few states, such as Pennsylvania, physicians recently have been upset over Aetna's declaration, in a letter to doctors, that the 125% is the "maximum state mandated rate." The Pennsylvania Medical Society said its state has no such rate.