Why we are dropping Aetna…

June 15, 2011

As we wrote about in our blog last October, Aetna Healthcare made several changes that have been very unfavorable towards naturopathic physicians.  Aetna decreased our reimbursement rates beginning 12/1/10, and is now the worst payer towards ND’s.  Their reimbursement is at least half of many other companies.  Despite writing letters, Aetna has held firm to their belief that we as ND’s are being “more than adequately compensated for our services”.  We have been discussing what to do regarding our “in-network” status with Aetna since this time, and have finally decided that we will be terminating our contract with them, effective  06-07-2011.  This has been a very difficult decision for us as we so deeply value the established relationship we have with you and your family!  We are on your team, and yet we also need to keep our doors open so that we may continue to provide you with the level of care you deserve.

So, what does this mean for you?  We will be “out of network” providers for Aetna as of September 7, and will continue to be able to provide care for you utilizing your out of network benefits.  Although you will be required to pay in full at the time of service, we will provide all necessary paperwork for you in a postage paid, addressed envelope to send directly to Aetna.  Depending on your benefits, you will be reimbursed a portion of your out of pocket expense.  This is often 60%, although you will need to call the customer service number on the back of your card to clarify what your individual “out of network” benefits are.

For example, if your visit is for a chronic or complicated issue, and lasts 20-35 minutes; your visit will likely cost $152.00.   If your out of network reimbursement is 60%, Aetna will send you a check for $91.20.  Therefore, your total out of pocket expense is $60.80.

If you are coming in for an acute, uncomplicated issue (sore throat, earache, bladder infection, etc), and your visit lasts 10-20 minutes, your visit will likely cost $105.  If your out of network reimbursement is 60%, Aetna will send you a check for $63.00, and your total out of pocket expense is $42.

If you have the ability to change insurance companies, we will continue to be preferred providers for Regence, Premera, Uniform, First Choice, and Lifewise.

Please do not switch to Cigna, Greatwest, or United, as their reimbursement is almost as poor and we may be terminating our in network contracts with them in the near future.

As always, we are here for your questions and concerns.   We truly thank you for your support in this. We want to continue to provide you with the very best care possible and also feel like we can support the continuation of our business.

Sincerely,

Tamara Cullen, ND

Amy Hawkins, ND

Carly Bridge, ND

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