Home Forums Discussions General Discussion Aetna Provider Network?

Recently one of the largest groups in our state changed their plan administrator to Aetna Health Plans. To date we have avoided contracting with carriers whenever possible, but as this affects such a large portion of our patient population, we're considering the possibility.
Do any of you have experience with being an Aetna provider? Any warning for me? Any positives?
I have to say that we've had more than one battle with them so I'm beyond concerned about the whole thing.
Thanks for your help!
Amber

They pay the least. Even less than Humana.

I accept Aetna. They pay the least of any of our commercial carriers. Even more frustrating than that is that when they need a referral, I can't find a specialist who will take them.

That was my fear. I have trouble with them as an out of network provider because they apply the coding guidelines in strange and frustrating ways (an E&M plus a Vaccine gets a multiple procedure reduction...what???). I was really hoping that you all would have better news for me, but I'm not surprised in the least. Thank you for your input.

I am quite bitter about Aetna. We were getting "reasonable" reimbursement rates while belonging to an IPA group that contracted with Aetna. Aetna decided that they would no longer negotiate with the group but only with the individual practices. They approached me with the offer of paying at a rate of 50-60% Medicare reimbursement rates. Now this rate barely covers my overhead. We told them to go take a F... hike and never looked back. Aetna comprised 20% of my patient population when this happened. We did survive but can't understand how some of the local practices accepted their deal.

DrAC,
I wonder why any physician service contracts with any insurance carrier. I realize that's where we're headed, but I also wonder if we refused to play ball what they would do. I have to think it isn't in the patient's best interest to let their insurance choose who they see, how often, and why. Yet the insurance sure seems to hold the cards which is why I am reading through pages and pages of the Aetna contract this morning. Sad.
Amber

I've been wondering about these questions for a few years now. Regardless of how much the insurance companies cheat physicians, especially in primary care where they try to pay you so little you can't even stay open because they don't want to value mental/analysis part of what you do but only procedures, few physicians opt to attempt the "Direct Primary Care" model (That's a Concierge practice priced for the average person.) Or even just to drop the lower paying plans. Now the larger plans have begun paying less than the smaller plans.

We began trying to build this back before President Obama took office, or even planned to run. We had very limited success (not really sure I can call it success) and the Affordable Care Act torpedoed many efforts since many of those uninsured may now be insured.

But what I think needs to happen is that PCPs have to build up a self-pay business to the point that they can drop plans that don't pay them properly. Enough so that their members can't get an appointment with a network doctor. That is the only way to get them to respect you...find a way to effectively use your power en mass and use it against them to effect their bottom line. Because they are affecting yours.

Wayne,

I could not agree more but unfortunately I do not see that happening. I am still getting requests for records from Anthem so they can meet their Medicare audit requirements. Well, after I closed my office and moved my server it would not boot back up and so it took a while for me to get it repaired. I told them I would not be able to get their records for them until it was. I got an email from them yesterday almost demanding that I get the records to them NOW! My reply was, "Gee, I am so sorry about your time constraints but that will just not be possible. You see, since your insurance company failed to pay me a fair wage I was forced to close my business and I now have no employees to do your record work. And, I am too busy right now trying to make a living and to pay for the repairs on the server that now have to come out of my pocket that I simply do not know when I will be able to copy those records for you. But, I will get them for you when I can get around to it."

Leslie,

You complete me.

JamesNT

I love it....

There is no "like" button here. If there were...

Leslie, I know what you mean. There just are too many "insurance whores."

Look at adult vaccinations. The insurance companies pay too little for you to offer this service profitably. Many doctors stopped providing the service. But, there are so many who still just accept the unviable reimbursements from the insurance companies that those who try to do that as a business can't get the volume needed. And many of those who do try it make the age-old mistake of small businesses...they don't charge enough for the product/service, sometimes charging as low as the insurance reimbursement feeling that this is much better because at least they don't have to file claim and wait for the reimbursement. I have found a couple places actually providing the services darn near at cost! Luckily, they don't advertise so most people only know about them by word of mouth (which is how I found out...one of our regular patients bragged to us about how little this place charged, then proceeded to try to ask Alice medical questions about the vaccinations that they didn't take the time to answer. She told them they needed to go back and ask the physician who administered the vaccination.)