Aetna’s Cuts to Pathology Services Averted in North Carolina

The leadership of the NC Society of Pathologists (NCSP) recently learned of a proposal by Aetna to unilaterally modify its national laboratory fee schedule beginning July 1.  Under this shift, large pathology practices would see payment rates for basic services drop to 45-50 percent of current Medicare rates.  The North Carolina Medical Society (NCMS) and NCSP have consistently opposed unilateral fee schedule reductions by health insurance companies, and have worked effectively in the past to prevent such reductions from taking effect.

After NCMS and NCSP raised a direct interest in the revised fee schedule for national labs, Aetna decided not to implement these drastic cuts in North Carolina as planned.

We believe Aetna’s decision is based on North Carolina’s Fair Contracting Law, which requires health insurers to first propose fee schedule modifications to in-network doctors via a written contract amendment, provide a 60-day period for review, and an opportunity to object to the proposal.  In this instance, Aetna had not followed the required process and has not indicated whether it plans to in the future.

The NCMS and NCSP consider this a major victory in our continuing effort to defend physicians from unfair health insurer practices.


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