Re: Paying less than $16 per hour not fair: Aetna CEO
RANDY LOYA
Description
Collection
Title:
Re: Paying less than $16 per hour not fair: Aetna CEO
Creator:
RANDY LOYA
Date:
1/23/2015
Text:
We have been working with Aetna for almost two years to gain in-network
status. We were part of a network that was considered in-net and we were
paid close to Medicare rates. When the network dissolved, we joined other
networks that had a national contract with Aetna. We later found out that
this still does not mean that we will be paid as an in-net provider. After
applying directly with Aetna we received the same proposed reimbursement
rates mentioned by Mr. Fenton. I tried to negotiate by sending them a cost
analysis for our top services with their proposed rates and the rates they
have paid us in the past. This went nowhere and they would not consider
any carve outs. I had to go up the chain until I finally spoke to a
regional manager. She told me that they are not really accepting any more
ancillary providers but she might could make an exception. She then went
on to say ...but you are not going to like our in-network rates. I asked
her why the rates were so low and how she expected us to operate losing
money and she did *not* have a good explanation. She told me that it would
be best for me to call in as an out-of-network provider, try to get a
network deficiency, and *try* to negotiate the rate at that time. So,
ultimately, we have to do more work to possibly increase the rates that
*might* cover our cost. With more man hours added to the equation we might
as well cancel out any increase in reimbursement...thus making the final
reimbursement, once again, lower than our cost. Oh...and she did say that
if we were part of a large network comprised of a certain large,nationwide
O&P company, we would get better rates. Ugh!
I believe that one of the biggest reasons for the downfall in Healthcare is
that insurance companies were allowed to start offering reimbursement rates
that were lower than the state and federal government programs. This
started a downward spiral that is not going to be easy to reverse.
Providers will start cherry picking the insurance companies that will
reimburse more and/or refusing patients with insurance companies that do
not reimburse well and the only people that will suffer will be the
patients. All of us are here (or should be)...for the patients! If Aetna
wants to re-invest in their employees so they don't have to suffer or live
in poverty they should also think about investing in the healthcare
providers that have to take care of those very employees along with the
patients they service. Otherwise these employees and Aetna-insured patients
may have to drive around in circles trying to find providers that will
actually accept their insurance and take care of them. Being asked to
accept rates that are well below our cost is an absolute slap in the face
and a degradation to our profession. The fact that Aetna is only willing
to negotiate with a certain large, nationwide O&P company is also a slap in
the face to everyone else *not* associated with this certain large,
nationwide O&P company.
--
Randy Loya, LAT, COF, COA
Operations Manager/ Practitioner
Central Texas Orthotics & Prosthetics, LP
*Helping people regain their independence one step at a time...*
On Wed, Jan 21, 2015 at 9:57 AM, Jim Fenton < <Email Address Redacted> > wrote:
> Good Morning List Serve:
>
> I thought you would be interested in this story I found on MSN (CNBC):
> Paying less than $16 per hour not fair: Aetna CEO
> < <URL Redacted>> <URL Redacted>
>
> Below is my response. I would encourage others to join with me and express
> your thoughts.
>
> I read your article today and I need to call out Aetna's CEO and Chairman,
> Mark Bertolini. He is quoted: Aetna raised employees' wages to a base of
> $16 per hour because paying them less was not fair.
>
> Mr. Bertolini, as accomplished as he is, needs to look a little farther
> than
> the end of his nose. His corporation, along with other large health
> insurers
> is paying on average, approximately FORTY PERCENT of what Medicare allows
> for Durable Medical Equipment and Orthotics and Prosthetics
> services/equipment. His corporation believes, along with other insurers
> that
> all orthotic and prosthetic devices are in stock and can be dispensed by
> clerks and therefore, there is no need to pay more.
>
> Many of the Aetna allowables do not pay enough for the
> Orthotist/Prosthetist to purchase the device itself; never mind the
> overhead
> to keep the doors open. If you find this hard to believe, call several
> Aetna
> in-network providers of orthotics/prosthetics devices and try to get an
> appointment to be fitted with a Name Brand ACL knee brace. Hint: that
> device
> costs the provider approximately $200.00 more than Aetna reimburses. To
> provide a Cervical Halo for a cervical fracture, the short fall
> approximately $500.00. I could continue, but I think you get the idea.
>
>
>
> Mr. Bertolini is Blowing Smoke .. .... ...! (Touting Aetna as the real nice
> guy in health care.) I don't begrudge his employees a penny of the
> $16.00/hour but there are also thousands of health care providers who also
> feel that paying us less is not fair.
>
>
>
> Orthotists/Prosthetists are by and large Board Certified and in many
> states
> required to be Licensed by The State to be able to practice. The licenses
> typically require a Baccalaurate or Masters Degree along with a residency
> for each discipline one wishes to practice. Aetna knows this and yet has
> elected to pay their employees more while continuing to ride on the backs
> of
> the health care providers who provide for their insured.
>
>
>
> R. James Fenton, LPO
>
>
>
>
> ********************
> To unsubscribe, send a message to: <Email Address Redacted> with
> the words UNSUB OANDP-L in the body of the
> message.
>
> If you have a problem unsubscribing,or have other
> questions, send e-mail to the moderator
> Paul E. Prusakowski,CPO at <Email Address Redacted>
>
> OANDP-L is a forum for the discussion of topics
> related to Orthotics and Prosthetics.
>
> Public commercial postings are forbidden. Responses to inquiries
> should not be sent to the entire oandp-l list. Professional credentials
> or affiliations should be used in all communications.
>
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
status. We were part of a network that was considered in-net and we were
paid close to Medicare rates. When the network dissolved, we joined other
networks that had a national contract with Aetna. We later found out that
this still does not mean that we will be paid as an in-net provider. After
applying directly with Aetna we received the same proposed reimbursement
rates mentioned by Mr. Fenton. I tried to negotiate by sending them a cost
analysis for our top services with their proposed rates and the rates they
have paid us in the past. This went nowhere and they would not consider
any carve outs. I had to go up the chain until I finally spoke to a
regional manager. She told me that they are not really accepting any more
ancillary providers but she might could make an exception. She then went
on to say ...but you are not going to like our in-network rates. I asked
her why the rates were so low and how she expected us to operate losing
money and she did *not* have a good explanation. She told me that it would
be best for me to call in as an out-of-network provider, try to get a
network deficiency, and *try* to negotiate the rate at that time. So,
ultimately, we have to do more work to possibly increase the rates that
*might* cover our cost. With more man hours added to the equation we might
as well cancel out any increase in reimbursement...thus making the final
reimbursement, once again, lower than our cost. Oh...and she did say that
if we were part of a large network comprised of a certain large,nationwide
O&P company, we would get better rates. Ugh!
I believe that one of the biggest reasons for the downfall in Healthcare is
that insurance companies were allowed to start offering reimbursement rates
that were lower than the state and federal government programs. This
started a downward spiral that is not going to be easy to reverse.
Providers will start cherry picking the insurance companies that will
reimburse more and/or refusing patients with insurance companies that do
not reimburse well and the only people that will suffer will be the
patients. All of us are here (or should be)...for the patients! If Aetna
wants to re-invest in their employees so they don't have to suffer or live
in poverty they should also think about investing in the healthcare
providers that have to take care of those very employees along with the
patients they service. Otherwise these employees and Aetna-insured patients
may have to drive around in circles trying to find providers that will
actually accept their insurance and take care of them. Being asked to
accept rates that are well below our cost is an absolute slap in the face
and a degradation to our profession. The fact that Aetna is only willing
to negotiate with a certain large, nationwide O&P company is also a slap in
the face to everyone else *not* associated with this certain large,
nationwide O&P company.
--
Randy Loya, LAT, COF, COA
Operations Manager/ Practitioner
Central Texas Orthotics & Prosthetics, LP
*Helping people regain their independence one step at a time...*
On Wed, Jan 21, 2015 at 9:57 AM, Jim Fenton < <Email Address Redacted> > wrote:
> Good Morning List Serve:
>
> I thought you would be interested in this story I found on MSN (CNBC):
> Paying less than $16 per hour not fair: Aetna CEO
> < <URL Redacted>> <URL Redacted>
>
> Below is my response. I would encourage others to join with me and express
> your thoughts.
>
> I read your article today and I need to call out Aetna's CEO and Chairman,
> Mark Bertolini. He is quoted: Aetna raised employees' wages to a base of
> $16 per hour because paying them less was not fair.
>
> Mr. Bertolini, as accomplished as he is, needs to look a little farther
> than
> the end of his nose. His corporation, along with other large health
> insurers
> is paying on average, approximately FORTY PERCENT of what Medicare allows
> for Durable Medical Equipment and Orthotics and Prosthetics
> services/equipment. His corporation believes, along with other insurers
> that
> all orthotic and prosthetic devices are in stock and can be dispensed by
> clerks and therefore, there is no need to pay more.
>
> Many of the Aetna allowables do not pay enough for the
> Orthotist/Prosthetist to purchase the device itself; never mind the
> overhead
> to keep the doors open. If you find this hard to believe, call several
> Aetna
> in-network providers of orthotics/prosthetics devices and try to get an
> appointment to be fitted with a Name Brand ACL knee brace. Hint: that
> device
> costs the provider approximately $200.00 more than Aetna reimburses. To
> provide a Cervical Halo for a cervical fracture, the short fall
> approximately $500.00. I could continue, but I think you get the idea.
>
>
>
> Mr. Bertolini is Blowing Smoke .. .... ...! (Touting Aetna as the real nice
> guy in health care.) I don't begrudge his employees a penny of the
> $16.00/hour but there are also thousands of health care providers who also
> feel that paying us less is not fair.
>
>
>
> Orthotists/Prosthetists are by and large Board Certified and in many
> states
> required to be Licensed by The State to be able to practice. The licenses
> typically require a Baccalaurate or Masters Degree along with a residency
> for each discipline one wishes to practice. Aetna knows this and yet has
> elected to pay their employees more while continuing to ride on the backs
> of
> the health care providers who provide for their insured.
>
>
>
> R. James Fenton, LPO
>
>
>
>
> ********************
> To unsubscribe, send a message to: <Email Address Redacted> with
> the words UNSUB OANDP-L in the body of the
> message.
>
> If you have a problem unsubscribing,or have other
> questions, send e-mail to the moderator
> Paul E. Prusakowski,CPO at <Email Address Redacted>
>
> OANDP-L is a forum for the discussion of topics
> related to Orthotics and Prosthetics.
>
> Public commercial postings are forbidden. Responses to inquiries
> should not be sent to the entire oandp-l list. Professional credentials
> or affiliations should be used in all communications.
>
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
RANDY LOYA, “Re: Paying less than $16 per hour not fair: Aetna CEO,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/237029.
