Correction -- Urgent Attention Required -- ACN/Aetna Workers’ Compensation Access, LLC Program

ACN/Aetna Workers’ Compensation Access, LLC Program Last month, NYSCA sent out a notice concerning ACN’s mid-December mailing announcing a “new network access program” – the “Aetna Workers’ Compensation Access, LLC Program,” a Workers’ Compensation (WC) Preferred Provider Organization (PPO). Unfortunately, the NYSCA has learned, an ACN staffer gave out the wrong fax number participating providers to use if they were interested in opting-out of the ACN/Aetna program. Since the error was ACN’s, the NYSCA feels that ACN should honor opt-out requests sent and received already albeit to the wrong ACN facsimile number. Nonetheless, to be doubly sure that opt-out information has been properly received, the NYSCA recommends that providers re-fax their opt-out letters again to (763)595-3333, even if you sent an opt-out letter once already. It is the Association’s understanding the correct facsimile number for opting out of this program is (763)595-3333. Remember, this offer on the part of ACN and Aetna is not magnanimous. Everyone, but you and patients injured on the job, may benefit from this program. In theory PPO providers offer their services at a discounted rates with the hope of gaining a larger volume of covered patients attracted by the lower fees which more than offsets the discounts being offered. Although the theory works fine for payers, providers rarely see the boost in practice volume necessary to offset the loss in income from discounting their fees. Keep in mind too, that if you agree to join this Aetna/ACN WC PPO network your fees will be discounted off of the already low NYS WC fee schedule. As NYSCA noted before, one of the most frequent complaints the NYSCA receives questions why the chiropractic WC fees are so low and why they have not increased in more than ten (10) years. Furthermore, it is the NYSCA’s understanding that subsequent to the original ACN/Aetna mailing, ACN/Aetna sent out a revised fee schedule, one that more closely reflects the few services chiropractors can bill for under the NYS WC fee schedule. If you sign onto this program, in effect, you are directing Aetna/ACN to discount your already low WC fees. Caveat Scriptor. Remember too, to beware of fine print with hidden liabilities. By joining the Aetna WC PPO not only will signers discount their fees but they will be subject to other provisions of NYS Law embedded in the WC law. For example, the “Compliance” portion of the Appendix accompanying the ACN/Aetna solicitation references NYS WC Article 10A directing WC PPOs like the ACN/Aetna program to comply with other portions of NYS law, including Article Art 49 of the Public Health Law. Under Art. 49 Aetna/ACN WC PPO are “utilization review agents” required to “determine whether health care services that have been provided, are being provided or are proposed to be provided to a patient . . . are medically necessary.” By signing this agreement you will not only be agreeing to discount your fees but you will be agreeing to whatever treatment parameters Aetna/ACN decide are medically necessary for your injured WC patients. Caveat Scriptor. And as the NYSCA pointed out before, Aetna and ACN are not creating any new lines of business in New York. WC law already requires every employer to cover employee injuries received on-the-job either by self-insuring or through the purchase of WC insurance. Aetna and ACN are not adding any volume of new, untapped patients that you do not have access to already. To the contrary, Aetna and ACN are only creating new lines of business for themselves at your expense. They are offering your services at discounted fee$ to employers with the added prospect that utilization will be controlled as well. This inures to the benefit of Aetna/ACN and employers who contract with their WC PPO.its contracted employers. If you think you deserve le$ or that Aetna/ACN needs more profit at your expense, then . . . Caveat Scriptor. ACN Group has not been telling participating providers that they can opt-out of this program. In order to do so, it is the NYSCA’s understanding that participating providers must affirmatively opt-out by faxing a letter to the ACN Group at (763)595-3333 advising ACN/Aetna them that you “formally withdraw your participation in and from the Aetna Workers’ Compensation Access, LLC Program.” It is also recommended that you make clear your intent to remain in network with any other ACN Group products in which you are currently enrolled, if you choose to do so. Even if you sent an opt-out fax once already to the previous number ACN communicated in error, to be doubly sure your opt-out letter is properly received, the NYSCA recommends that you re-send your opt-out letter to the following number: (763)595-3333. For definitive opt-out information contact ACN Provider Services at 888-676-7768.