MAR 31, 2022
Major Reimbursement Cuts From Aetna Surprise Florida Practices
A number of Orlando and South Florida practices have reported unexpected cuts in Medicare Advantage reimbursement rates from Aetna, the Academy has learned.
The Academy has received a number of reports from practices in the area that Aetna intends to reimburse only 75% of what Medicare allows for certain ophthalmological procedures under the Aetna’s fee schedule. The services include eye surgery, CT scans and ophthalmology and radiology services. The changes are effective beginning May 1.
The Academy actively is monitoring this issue out of concern the rate reductions are potentially an intentional effort to narrow Aetna provider networks and/or drive-down in-network rates in response to the Jan. 1 implementation of the No Surprises Act. The act is intended to prevent patients from getting surprise medical bills for emergency and nonemergency services.
Here are a number of steps you can take so that you’re not caught off guard:
- Examine contract renewals with Aetna carefully. Request a written explanation if there is a rate reduction.
- If your practice is notified of a negative rate adjustment, contact the Academy at email@example.com to report it.
Review the Academy’s webpage on surprise billing.