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Aetna lowers ambulance reimbursements

Managed Care Weekly Advisor, July 18, 2007

Aetna is reducing the rate for ambulance services nationwide, and the effects of the cuts are still being calculated. The reduction will only affect ambulance companies that do not have contracts with Aetna; smaller, nonprofit or municipal services will feel the pinch. The Hartford, CT-based insurance provider said the lowered reimbursements are from a company rule that has only recently been enforced.

An undetermined number of HMO subscribers will likely be impacted when ambulance companies bill them for services that Aetna does not cover; if this occurs, Aetna officials say the members will be reimbursed. The rule states that Aetna will pay 125 percent of what the federal Medicare program would provide for an emergency trip.

According to the Hartford Courant, the policy also does not apply to non-emergency transport by ambulance, because subscribers must use Aetna-contracted ambulances for non-emergency rides. These rides are covered if Aetna determines them to be medically necessary.

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