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Insurance Carrier: Aetna And Cigna
State: Georgia

Consumer Complaint:

We are a group on anesthesiologists working at a hospital that provides a disproportionate amount of government care and as such the payers that provide volume to us are given managed care rates. Aetna and Cigna provide several thousand cases for our group but far below the threshold for managed care rates. They are categorized as private commercial payers. They have refused to allow their patients to consider our hospital in network unless we discount our fees approx. 40%. This is a significant loss of revenue to our small anesthesiology practice. The hospital is pressuring us to take the cut because there out of network balance bill to the patient makes them very unhappy. We have told the companies that we will provide them discounted rates based on their volume. It is very discouraging to provide complicated anesthesia services and to be compensated on a per unit basis less than 25%tile in the country. I do not know where to turn. It is unfair to be bullied into discounts and unfair to place that burden on the patients as well. Can you offer me someone to discuss this in more detail?

Insurance Expert Answer:

The problem you face -- being forced by a health insurance company to cut your rack rates dramatically -- is not unique to your practice. It's happening nationally, and the the impact depends on the percentages of private pay vs. Medicare vs. managed care vs. insured patients you have.

The problem is one to discuss with the AMA, your state legislators and your Congressional representatives. Just to make you feel better, Wal-Mart and Home Depot also pressure their suppliers.