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Re: Aetna From: jkulkin (jkulkin@mindspring.com) Mon Nov 27 20:24:53 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Karen Lee: "Re: The case of irritating ejaculate..." Previous message: Garry Siegel: "OB: What is a late deceleration? (case and discussion--long)" Maybe in reply to: Deborah J. Wage: "Aetna" I'll check it out in detail tomorrw but my gut tells me this is right. There is typically a contract with in network providers to use in network facilities. Think about it for a minute. It makes sense for the payer to encourage utilization of physicians that they contract with and it makes sense to use facilities where contracts offer favorable rates. The disincentive for the member to use even an out of network facility is a reduced benefit. This is a major disincentive for the member with significantly greater out of pocket expense. For those physicians in network it is a mechanism to protect them by the payer as well. Sorry guys but I'm OK with this. If an in network doc wants to optomize the patients benefit then take them to the in network facility UNLESS there is a quality issue for the service needed. In that case special arrangmeents may be necessary! JK Garry Siegel wrote: > I find this unbelievable and have never heard of such a > >thing with any other insurance company. Anyone else? > > > >Deborah Wage, MSN, FNP,CNM > > Yes, I've heard of this, although I can't remember if it was Aetna, or > someone else. I wonder what the rationale is behind this. Can any > insurance folks such as Jay or Bernard Greenberg shed some light in > addtion to what Alan said? > > Garry > > -- > Garry E. Siegel, M.D., F.A.C.O.G. > Roswell, GA > Private Practice Next message: Karen Lee: "Re: The case of irritating ejaculate..." Previous message: Garry Siegel: "OB: What is a late deceleration? (case and discussion--long)" Maybe in reply to: Deborah J. Wage: "Aetna"

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