Last week, NCMS alerted the NC Department of Insurance (DOI) to Aetna’s plan to cut the reimbursement rates of mid-level providers to 85% of the contracted physician rates, effective July 1. Read last week’s post and NCMS’s letter to DOI here.
DOI has since indicated to NCMS that they intend to handle the matter as a consumer services complaint. Currently DOI is awaiting a written response from Aetna, which is due next week. DOI pledged a prompt review and an intention to avoid a drawn out dispute. If DOI considers the facts and the law and determines that Aetna’s policy change does not meet the requirements of the fair contracting laws, then DOI is authorized to take additional action as appropriate.
