Aetna Prohibits Access to Medical Services for self-pay patients

Aetna has prohibited Houston members from receiving Airrosti therapy (rapid recovery therapy) on a self-pay basis for the past two months.

Airrosti was a Aetna participating provider. Airrosti physicians perform their services within primary care physicians offices here in Houston. The problem began when Aetna and Airrosti entered in contract

negotiations two months ago. Aetna threatened their PCP'S with contract violation and possible contract termination if their Houston members

received Airrosti therapy on site. As such, Houston Aetna patients couldn't receive Airrosti therapy on a cash or out-of-network basis.

Aetna's legal department recently ruled that members could receive Airrosti services on a self-pay or out-of network basis. Such services

would be process under Airrosti separate tax ID. Aetna's recent communication

to their PCP's reiterated the risk of contract violation and termination if PCP's violate their fiduciary responsibilities to Aetna by referring

to out-of-network providers.

It is illegal for a health care provider to limit access to medical services for their members on a self-pay basis. Aetna commands approximately 30% of the Houston patient population.

Outraged? Contact:

Doris Smith

Aetna Corporate Legal Resolution

Aetna

151 Farmington Avenue

Hartford, CT 06156

860-537-0284

Donna Parker

Comments (2)

1. Written by Donna Parker, on 27-08-2008 16:43 Jeff,    There is absolutely no mistake here. No misunderstanding. Aetna who remains in contract negotiations with AIRROSTI prohibited all Houston area patients from receiving services on a cash or out of network basis for several months. AIRROSTI services are performed within primary care offices. All Houston PCP's with AIRROSTO physicians were threatened with contract termination if they referred/allowed Aetna patients to receive AIRROSTI therapy on-site.  No insurance company should be able to prohibit access to healthcare on a cash basis! Doris Smith is the head of the legal resolution team at Aetna Corporate Headquarters. I am simply an exasperated Houston patient!! Report

2. Written by jeff, on 27-08-2008 14:57 Doris,  Aetna does not control the techniques PCP's provide in their offices. Airrosti technique is not covered under the contract between PCP and Aetna. So the patient pays for the service. Report

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