Fulcrum Strategies, a Raleigh firm that represents practices in managed care contract negotiations, recently alerted North Carolina Medical Society (NCMS) staff to a concern with some contractual language they were seeing. NCMS staff was able to resolve the problem after alerting the NC Department of Insurance. Here’s the update to his clients from Fulcrum CEO Ron Howrigon:
“Several of you who are in negotiations with Aetna have been struggling with some very concerning language in the new Aetna contract that would allow Aetna to penalize groups for the use of non-participating providers.
“Late last week I was informed by Conor Brockett, the Associate General Counsel of the North Carolina Medical Society, that he and the Medical Society on behalf of the physicians of North Carolina expressed their concerns about this language and questioned if it was in compliance with [state law].  The Department discussed the language with Aetna and Aetna agreed to remove the language from all contracts in North Carolina.
“This is another example of the value that the North Carolina Medical Society brings to physicians practicing in North Carolina.  The Medical Society… continues to make sure that all payers continue to abide by that law and its requirements.”