Aetna Deselecting 130 Texas Physicians

Aetna has notified 130 Texas physicians it will terminate them from its networks on July 1, TMA's Payment Advocacy Department has learned. Aetna says it told the physicians a year ago it was concerned about their billing patterns. Evaluation and management (E&M) codes were the only ones Aetna examined, and its concern involves primarily levels 4 and 5 E&M codes.

Aetna says in letters to the deselected physicians that its data shows their billing and coding practices caused them to be more costly than their peers. TMA secured legal protections in Texas that require Aetna to tell physicians why they are deselected.

TMA has developed a white paper on physicians' basic rights and responsibilities in network terminations. It is not specific to Aetna; any physician deselected by any health plan network can use it.

The 130 Texas physicians are among doctors nationwide that Aetna is removing from its networks. The action has sparked outrage by physicians. One physician posted the following comment on TMA's Blogged Arteries: "How does Aetna have the arrogance to admit that these 130 docs cost them too much from their bottom line? What about the patients they're leaving in the lurch? Anybody care about them?"

Nationally, some of the outrage is directed toward Aetna Chief Executive Officer Mark Bertolini. The Hartford Courant reported that one New Jersey physician, John Tedeschi, MD, posted a video on YouTube in which he said he tried contacting Mr. Bertolini, but was told he doesn’t speak to physicians.

He says in the video that he is amazed a physician "trying to save lives and help individuals, is controlled by an individual that made $8 million last year. And he’s not a physician. He's directing health care. He's some great entrepreneur that's going to change the world in technology and he doesn’t have time to talk to physicians."

 


 Action, April 3, 2012