Aetna, WellPoint refuse payment for serious errors

As expected, large private health insurers are beginning to follow Medicare's lead in cutting off reimbursement for care resulting from serious errors. Aetna and WellPoint have begun to include provisions in some contracts that they won't pay for (or let patients be billed for) care related to 28 "never events" compiled by the National Quality Forum, including the death of a mother in a low-risk pregnancy, leaving instruments in patients after surgery and using contaminated devices. Aetna is including provisions in contracts with hospitals which bar payment for all 28 never event. WellPoint, meanwhile, is starting on a more limited basis, refusing payment for four of the 28 items in the list for insureds in Virginia. 

Aetna and WellPoint aren't alone. Other big insurers, including UnitedHealth Group and Cigna are considering moves, as are all 39 members of the Blue Cross Blue Shield Association. Meanwhile, hospitals in Minnesota and Massachusetts have voluntarily agreed to not charge for all or at least some of the 28 never events identified by the NQF.

To find out more about this trend:
- read this piece from The Wall Street Journal

Related Articles:
CO hospitals consider waiving payment for adverse events. Report
MA hospitals forswear payment for preventable errors. Report
By 2008, Medicare won't pay for hospital errors. Report
Business say 'no pay' for major mistakes. Report
Study: Wrong-site surgeries, close calls are common. Report

Post a comment