DOI to Aetna: Mid-Level Reimbursement Cut Did Not Comply with S877

Since January 2010, health plans seeking to modify medical fee schedules have been required to adhere to minimum standards regarding notice to doctors and timing of implementation. The NCMS identified flaws in Aetna’s implementation of a fee reduction to mid- level providers. When efforts to resolve the problems with Aetna were not successful, NCMS filed a complaint with the Department of Insurance and contacted the Attorney General’s office. Both DOI and the Attorney General’s office agreed with the position taken in the NCMS complaint that Aetna’s change in reimbursement policy constituted an amendment to physician and group contracts and was subject to North Carolina’s new fair contracting laws. The company has indicated to DOI that it will delay the scheduled June 1, 2010 implementation of the cut and take the necessary steps to comply.

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