We are having a problem with Idaho Aetna denying OB problem office visits as part of the global ob care, when clearly they are not. ie: URI, Headaches, skin rash, etc. Even after going through their "reconsideration" request (first level of appeal), with supporting documentation including CPT definition of ob global care and proof that we can charge separate office visits for unrelated problems, they are still denying it. It’s like they aren’t even reading my letters! We only get 2 appeals with Aetna, and this is a huge amount of money we are loosing. Now, they have started going back through visits they have already paid on, and taking their money back. I’ve audited all of these visits and they truly are reimbursable services.

I am at my wits end. Does anyone have any suggestions? Does anyone have this problem as well? We don’t have a provider relation rep assigned to us so I can’t complain to them, but seriously, Aetna can’t be withholding payments on billable services like this! HELP!