3P Update: Academy Advocacy Efforts with United Healthcare and Aetna Coverage Policies
James C. Denneny III, MD, Michael Setzen, MD, MPh, MA Jenna Kappel, AAO-HNS Health Policy Director Harrison Peery, AAO-HNS Health Policy Analyst During the last year, several Academy members have experienced reimbursement issues with larger insurers for procedures associated with rhinoplasty, septoplasty, and repair of vestibular stenosis. In response, the Physician Payment Policy (3P) workgroup, supported by Health Policy staff and Academy committees, have been working with Aetna and United Healthcare (UHC) to revise their medical policies. The Academy has written several letters during the past four years to UHC requesting changes to its clinical policy and has gradually received positive revisions from UHC. Many changes have been made to the policy on rhinoplasty, septoplasty, and repair of vestibular stenosis in response to our recommendations. In recent efforts, the Academy wrote another letter requesting that UHC make several modifications to the policy based on outstanding issues. Below is a table indicating how UHC has responded to the most recent Academy requests. The Academy, similarly, has initiated advocacy efforts with Aetna to change its rhinoplasty and septoplasty policy due to specific reimbursement issues members have reported to Health Policy. In April, 3P and Health Policy staff worked with the Rhinology and Paranasal Sinus Committee and the Facial Plastic and Reconstructive Surgery Committee to assimilate comments into a letter sent to Aetna. Notably, Russell W. H. Kridel, MD, and Steve Duffy of the American Academy of Facial Plastic and Reconstructive Surgery Association assisted with advocacy and along with 3P, participated on a recent conference call with Aetna executives. The Academy anticipates positive changes to Aetna’s policy and potential future collaborations with Aetna policy executives. These policy changes show how important it is for Academy members to advocate at the local level and keep Health Policy staff informed about reimbursement issues. It is important to nurture good relationships with medical directors and decision makers, get involved in the committee structures and be well prepared to present a cogent argument supported by clinical data. For more information on the Academy’s guidance in addressing local and state private payer denials, see http://bit.ly/payerdenials. “Persistence beats resistance” in most cases, according to Dr. Setzen. Regarding policy changes requested, but not accepted by UHC, the Academy continues to advocate for necessary revisions and sent a follow up letter to UHC in early August revisiting those concerns. If you receive an inappropriately denied rhinoplasty or septoplasty claim from an insurer, email healthpolicy@entnet.org so that we may track the issue. – See more at: http://aaobulletin.365.staging2.ascendmedia.com/Highlight.aspx?p=479&id=6354#sthash.AbUhGdqc.dpuf
James C. Denneny III, MD,
Michael Setzen, MD, MPh, MA
Jenna Kappel, AAO-HNS Health Policy Director
Harrison Peery, AAO-HNS Health Policy Analyst
During the last year, several Academy members have experienced reimbursement issues with larger insurers for procedures associated with rhinoplasty, septoplasty, and repair of vestibular stenosis. In response, the Physician Payment Policy (3P) workgroup, supported by Health Policy staff and Academy committees, have been working with Aetna and United Healthcare (UHC) to revise their medical policies.
The Academy has written several letters during the past four years to UHC requesting changes to its clinical policy and has gradually received positive revisions from UHC. Many changes have been made to the policy on rhinoplasty, septoplasty, and repair of vestibular stenosis in response to our recommendations. In recent efforts, the Academy wrote another letter requesting that UHC make several modifications to the policy based on outstanding issues. Below is a table indicating how UHC has responded to the most recent Academy requests.
The Academy, similarly, has initiated advocacy efforts with Aetna to change its rhinoplasty and septoplasty policy due to specific reimbursement issues members have reported to Health Policy. In April, 3P and Health Policy staff worked with the Rhinology and Paranasal Sinus Committee and the Facial Plastic and Reconstructive Surgery Committee to assimilate comments into a letter sent to Aetna. Notably, Russell W. H. Kridel, MD, and Steve Duffy of the American Academy of Facial Plastic and Reconstructive Surgery Association assisted with advocacy and along with 3P, participated on a recent conference call with Aetna executives. The Academy anticipates positive changes to Aetna’s policy and potential future collaborations with Aetna policy executives.
These policy changes show how important it is for Academy members to advocate at the local level and keep Health Policy staff informed about reimbursement issues. It is important to nurture good relationships with medical directors and decision makers, get involved in the committee structures and be well prepared to present a cogent argument supported by clinical data. For more information on the Academy’s guidance in addressing local and state private payer denials, see http://bit.ly/payerdenials. “Persistence beats resistance” in most cases, according to Dr. Setzen.
Regarding policy changes requested, but not accepted by UHC, the Academy continues to advocate for necessary revisions and sent a follow up letter to UHC in early August revisiting those concerns.
If you receive an inappropriately denied rhinoplasty or septoplasty claim from an insurer, email healthpolicy@entnet.org so that we may track the issue.
– See more at: http://aaobulletin.365.staging2.ascendmedia.com/Highlight.aspx?p=479&id=6354#sthash.AbUhGdqc.dpuf