With many healthcare providers expecting physician extenders to take up the slack forced by a pending shortage of primary-care physicians, a national plan by Hartford, Conn.-based Aetna Inc. to reduce payments to mid-level providers, including physician assistants and nurse practitioners, is meeting resistance from at least one quarter. The North Carolina Department of Revenue will review Aetna's plan after the North Carolina Medical Society in Raleigh filed a consumer complaint, reports The Business Journal of the Greater Triad Area.
In a March provider newsletter, Aetna announced that it will pay mid-level practitioners (i.e., nurse practitioners, physician assistants, certified nurse midwives and registered nurses) at 85 percent of the "contracted rates for covered professional services [consistent with the Centers for Medicare and Medicaid Services payment policy]" effective with June 1 dates of service in every state except Alaska, Kansas, Maine and Missouri.
The North Carolina Medical Society believes that the payment reduction amounts to a contract change for physicians and as such should trigger several state legal requirements, such as giving physicians a 60-day grace period to object and choose whether to remain in the Aetna network.
In a letter to the insurance department, the medical society's assistant counsel Conor Brockett relates that "informal talks between NCMS and Aetna have failed to produce shared understanding as to what the law requires in this scenario." Aetna regional counsel James Wolf, argues that the insurer can disseminate information about changes through the network newsletter if they are announced a minimum of 90 days in advance.