NYSCA Responds to Aetna’s 2007 PPO In-Network Fee Schedule

Insurance committee recently submitted a letter to Aetna which we hoped would persuade Aetna to re-assess their new 2007 PPO In-Network fee schedule. In the letter, we raised the five issues noted below: 1. Notification of Fee Schedule Changes: Fees were reduced without proper notification to your chiropractic panel members. Should participating doctors have advance notice to their fee schedule? If Aetna’s profitability falters, are Aetna’s salaried employees given notice prior to their reduction in salary or benefits? Even if there is found to be no legal obligation, is there no moral compulsion to treat in-network providers fairly? 2. Parasitic vs. a Symbiotic Relationship with Aetna Providers: Are In-network providers considered as members of the Aetna team? According to an Aetna press release (Feb. 8, 2007; found on the web at http://www.aetna.com/news/2007/pr_4thquarter2006_earnings.htm), there was a 29% increase in net operating income in 2006 vs. 2005. Why penalize members of your team, who in part, were responsible for this success? Philosophically, the survival of any provider contract should be predicated on a symbiotic relationship. If provider fees become predatory, then the relationship becomes parasitic and is doomed to failure. The desire to obtain short term financial gains may have dire long-term consequences, and the fall off may be precipitous rather than gradual. 3. Disproportionate Cutbacks in Chiropractic Reimbursement: Why were Aetna’s In-Network chiropractic codes reduced by 28%, while therapies and modalities were only lowered by 8 to 10%? Was this meant to be a direct assault on chiropractic? Is this in line with a pay-for-performance concept? Is this backed by the current literature or just performed at the whim of an anti-chiropractic stand by Aetna? If on the other hand, it is Aetna’s long-term goal to eliminate the chiropractic panel, then I see nothing wrong with your present tactics. Is Aetna’s long-term goal to eliminate the chiropractic panel? 4. Maintaining quality of care and subscriber enrollment: Being that there is no change in reimbursements to out-of-network providers (who receive ‘Reasonable & Customary”), are there any concerns as to attracting and keeping a high quality of provider within the Aetna network? I would think that a higher quality of provider leads to a higher patient satisfaction and more enrollees. A loss of good chiropractors from the panel can result in an attrition of Aetna enrollment (a reversal from the current trend). 5. Foster Team Spirit or Animosity & Resentment: In light of the fact that Aetna’s recent trend is toward greater (rather than lesser) profitability, In-network providers feel discouraged and betrayed by a lowering of their fee schedule. Both Aetna and Aetna’s providers are faced with increasing costs of operation; but whereas Aetna appears to be doing better, the same can not be said for their providers. The reduction just adds insult to injury, and fuels resentment as we care for your Aetna subscribers. Are In-Network providers considered part of Aetna’s team, or are we to be Aetna’s adversaries? The NYSCA has recently brought similar issues to another major carrier in the New York region, and they have agreed to return the fee schedule to the 2006 schedule. We sent a broadcast fax to all the chiropractors in NYS applauding the responsiveness of this Insurance Carrier. We will anxiously await your responses (or lack there of) so we can inform NYS chiropractors as to where Aetna stands on these issues discussed. Unfortunately, we just got word that Aetna will not change the new fee schedule, and Aetna has made a conscious decision not to respond to our letter as it can only lead to dissension. Many members are concerned that NYSCA is not fighting for our survival. Can members please send constructive suggestions as to how we might deal with situations such as this?

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