A new national program from insurance company Aetna aims to lower the number of out-of-network referrals for outpatient surgery procedures, according to a Healthcare Finance News report.
The company plans to alert members and their physicians if they are leaving the insurer's network for care. Once the member is alerted, the company will work with them to shift the referral to an in-network provider. Aetna says the aim is to alert members who may not know that an out-of-network referral could cost them more money. Aetna says shifting the care to in-network providers provides an average savings of $5,000 per incident.
The program depends on a precertification process that requires physicians to notify the insurer when they make an out-of-network referral to a freestanding ambulatory surgery center.
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The company plans to alert members and their physicians if they are leaving the insurer's network for care. Once the member is alerted, the company will work with them to shift the referral to an in-network provider. Aetna says the aim is to alert members who may not know that an out-of-network referral could cost them more money. Aetna says shifting the care to in-network providers provides an average savings of $5,000 per incident.
The program depends on a precertification process that requires physicians to notify the insurer when they make an out-of-network referral to a freestanding ambulatory surgery center.
Related Articles on Coding, Billing and Collections:
Illinois Rep Introduces Bill to Require Disclosure of ASC Charges
22 Statistics on Best Payors for Physicians by Specialty
New Jersey Legislation Could Force Out-of-Network Physicians to Accept In-Network Rates