Aetna refuses payment for never events, requires corrective action

Aetna has announced a new policy under which it will refuse to pay for care related to a group of 28 adverse events, and what's more, require providers to take a series of reporting and corrective steps to address the errors. 

Over the last couple of years, since Medicare announced its intention not to pay for care related to preventable errors, a number of health insurers have followed its lead. But in adding a set of requirements demanding specific types of follow-up, Aetna has set a standard that may be the toughest in the country where non-payment for preventable medical errors is concerned.

Aetna's new policy covers Serious Reportable Events--a category endorsed by the National Quality Forum--that covers never events such as wrong surgeries, wrong person surgeries or surgeries on the wrong side of the body.

Aetna providers must eat the entire cost of caring for patients who have suffered the three never events, and also waive charges "directly and solely" related to eight other SREs. Also, they must take the following corrective steps:

* Notify Aetna and at least one agency concerned with patient safety (Joint Commission, state medical error reporting programs or patient safety organizations)

* Analyze factors contributing to the problem and find ways to improve patient care systems and processes

* Communicate with the Aetna member and/or member's family about the event

All told, Aetna's plans appear to be the most comprehensive we've seen cross our desk. It will be interesting to see whether they harmonize with ongoing industry initiatives to reduce errors or produce red tape instead.

To learn more about Aetna's policies:
- read this company press release

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