Insurance News:

Changes to Aetna Program Effective 09/01/18

by NYSCA Insurance Committee | 8/27/2018 5:09:03 PM

Do you treat Aetna patients?  Are you aware that Aetna is changing their physical medicine program effective 9/1/18?

The NYSCA has received numerous calls from our members regarding Aetna's change in their physical medicine program.  This change is significant and will impact your practice. 

What we do know:

  • Aetna will discontinue their relationship for Optum/UnitedHealthcare for administration of chiropractic services.
  • Aetna will be utilizing their own network of providers, which requires you to contract or renew your contract with Aetna.
  • Authorization will be required by a new group, NIA, for all services rendered on or after 9/1/18.
  • Claims are to be submitted to Aetna (via EDI as is currently required) after you receive authorization from NIA (we anticipate NIA will upload their authorizations to Aetna).

NIA is advising providers to contact Aetna's Provider Service Department for any questions regarding benefits. Aetna's dedicated provider relations manager is Charmaine Gaymon-Everett who can be reached at 800-450-7281, ext. 32615. Aetna's physical medical project lead is Shiron Hagens, who can be reached at [email protected] (we do not have a phone number for her at this time).

The NYSCA is quite concerned of the limited communication submitted to date.  Some of you began to receive contracts late last week.  It is our understanding that there is no fee schedule or detailed utilization review description for you to evaluate with your contract.  Apart from supplying members with factual information, Federal antitrust laws do not permit the Association to advise you to sign or not sign a contract with any health care payer or provider, or their third party administrator; nonetheless, we do recommend that you make an informed decision.  It is prudent to review what your obligations and reimbursement are as part of that process.

The NYSCA would like to thank Dr. Robert Martin, Dr. Joseph Merckling, Dr. Gregori Pasqua, and Dr. Robin Stein who have been in contact with Aetna in an attempt to ensure NYSCA members are duly notified and informed with appropriate details of the program change.

At this point we are attempting to put together more detailed information and await further feedback from Aetna; however, you are encouraged to contact Aetna to see how this impacts the care of your Aetna patients.

Source

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