Anyone See Aetna's Fee Schedule? OUCH!

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WEBB PINKERTON

WEBB PINKERTON

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Effective July 1st, 2013

Just a few common codes for your viewing pleasure...

88305 = 35.05
88342 = 57.67
88142 = 13.93
88313 = 30.47
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CPT 88142 Cytopath c/v thin layer $13.93

It costs about $7 to make the ThinPrep. So you get $6.93 cents to pay the cytotech, the prep tech, then yourself.
 
WEBB PINKERTON said:
Effective July 1st, 2013

Just a few common codes for your viewing pleasure...

88305 = 35.05
88342 = 57.67
88142 = 13.93
88313 = 30.47
Click to expand...

That is not what our contract with them pays. And they don't have the unilateral right to change it.
 
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WEBB PINKERTON said:
Effective July 1st, 2013

Just a few common codes for your viewing pleasure...

88305 = 35.05
88342 = 57.67
88142 = 13.93
88313 = 30.47
Click to expand...

Are these global or professional?

An FDA approved immuno like ER, CD117, PR, HER-2 costs more than that to produce. If you are just doing billing an 88342, then you are definitely losing money.

Man, we are getting squeezed from all ends. The money we collect is going down, our costs go up, and Obama wants our taxes to go up further because he thinks the point of our careers, hours spent training and dedication is to fund the government social programs.

Actually that has to be the global as the pc in and 88342 is only around 35 from Medicare.
 
Last edited:
Silent Cool said:
What is a typical take-home? 250K?
Click to expand...
Not sure, honestly. According to our dept. leadership, starting salaries traditiionally begin upper 100Ks, depending on practice setting, geographic location, subspecialty.
 
I have no contract that pays that. None. If I did get the "national default Aetna contract rate" crap I would drop it instanteously.

No worries.

Now out in the community where Uro, GI and Derm etc docs are doing podlab arrangements for 50% of Medicare and are now pulling down 80% Medicare from Aetna, their margins just got a whole lot slimmer....
 
Attached.
 

Attachments

  • Aetna National Contract Default Fee Schedule. Update effective 07.01.2013.pdf
    88.9 KB · Views: 221
Dear Lord! Some of those rates are like 25% Medicare!!!

Im not even sure that is legal....at least in California. The law here disallows rates essentially below state Medi-Cal levels, which those well are.

NOTE: Everyone should pre-emptively exit Aetna's provider network. We cannot allow this to stand. This is an outrage.
 
Last edited:
WEBB PINKERTON said:
Effective July 1st, 2013

Just a few common codes for your viewing pleasure...

88305 = 35.05
88342 = 57.67
88142 = 13.93
88313 = 30.47
Click to expand...

I really wonder about this. Aetna is one of our worse payers (after Medicaid, Medicare and places like planned parenthood who pay medicare), and we a certain percentage over whatever the current Medicare fee is. I wonder if they put out these absolute rock bottom numbers based on their lowest reimbursement rates.
 
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pathstudent said:
Effective July 1st, 2013

Just a few common codes for your viewing pleasure...

88305 = 35.05
88342 = 57.67
88142 = 13.93
88313 = 30.47.
Click to expand...

This fee schedule is for the "independent labs" and not a "physician fee schedule". It is the basis from which other schedules are derived "up".
 
I guess they just want all their business going to Quest. No way you can make money with reimbursements that low. Some of those dont even cover supplies. Only large labs with scale are gonna survive.

If you are considering pathology, DONT DO IT.

The future is very bleak. Other insurance companies are going to follow suit. Hell, even the govenment is wanting client pricing now. Only large, miserable sweat shops will be able to make it. Do you wanna work for one of those? You will be doing this career for many years. Don't believe the idiots claiming a 4000 path shortage is coming in 2020. There will still be a surplus.
 
pathstudent said:
Are these global or professional?

An FDA approved immuno like ER, CD117, PR, HER-2 costs more than that to produce. If you are just doing billing an 88342, then you are definitely losing money.

Man, we are getting squeezed from all ends. The money we collect is going down, our costs go up, and Obama wants our taxes to go up further because he thinks the point of our careers, hours spent training and dedication is to fund the government social programs.

Actually that has to be the global as the pc in and 88342 is only around 35 from Medicare.
Click to expand...

Non-issue when we won't be paid the $$ anyway. :mad:

They dinged us pretty good a few years ago and are set to do it again. This centralized price fixing is getting to be a real pain in the ass.
 
KLPM said:
Wow, look at that url........
Click to expand...

Yea, that is pretty funny. One thing is sure, Aetna gonna make a lot of us POOR. Maybe I can get my URL to be poorwebbpinkerton on facebook.
 
Pathologee said:
CPT 88142 Cytopath c/v thin layer $13.93

It costs about $7 to make the ThinPrep. So you get $6.93 cents to pay the cytotech, the prep tech, then yourself.
Click to expand...

Why accept this contract at all?
 
Substance said:
Why accept this contract at all?
Click to expand...

Not speaking for him, rather, in general terms: sometimes some money is better than no money.

There truly is no such thing as strict "fixed" costs -- there are just variably variable costs. Unfortunately, in much of medicine, the biggest chunk of our costs are not very variable -- which leads us back to the topic above. In short, $6.93 in profit (it's really not $6.93 in profit, actually -- just $6.93 in profit for his particular cost structure) beats the **** out of $7 in the hole (which, similarly, is not $7 in the hole -- but you get the point).

To maximize profitability we generally accept most / every contract at first and then proceed to cut from the bottom as volume allows. If one does not have sufficient well paying volume, it is not nearly as easy to cull the herd. :(
 
Pap test code 88142 by itself is pretty much a money loser. Dont forget, you also have to pay for a very expensive proficiency test which usually costs our lab over 2000 dollars every year. Biggest insurance company in my state cut reimbursement on pap and hpv to peanuts in the last few years as well. Its a bad business to try to get into as we have found. The OBGYNs all sold their practices to hospital chain and thus the increase in volume at my facility.

The pull through business on this is all the HPV, GC/chlamydia, trichomonas and whatever else you can get them to order out of the liquid vial. You run hundreds of dollars of unnecessary molecular tests. Some labs are running 20+ tests off these vials, many non-fda approved home brewed tests for orgranisms extremely uncommon in the USA. Chancroid anyone? LOL.

I really wish that crap would stop and there was more oversight on these home brewed tests but that is how the labs are able to pull of doing gyn cytology.
 
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Webb why does your avatar look like an extra from The Purge?

Do you own a machete btw?
 
WEBB PINKERTON said:
Pap test code 88142 by itself is pretty much a money loser. Dont forget, you also have to pay for a very expensive proficiency test which usually costs our lab over 2000 dollars every year. Biggest insurance company in my state cut reimbursement on pap and hpv to peanuts in the last few years as well. Its a bad business to try to get into as we have found. The OBGYNs all sold their practices to hospital chain and thus the increase in volume at my facility.

The pull through business on this is all the HPV, GC/chlamydia, trichomonas and whatever else you can get them to order out of the liquid vial. You run hundreds of dollars of unnecessary molecular tests. Some labs are running 20+ tests off these vials, many non-fda approved home brewed tests for orgranisms extremely uncommon in the USA. Chancroid anyone? LOL.

I really wish that crap would stop and there was more oversight on these home brewed tests but that is how the labs are able to pull of doing gyn cytology.
Click to expand...

Interesting -- I have to argue not infrequently with payers (well, mostly Medicare) to get biopsy proven recurrent 2cm carcinomas with aggressive features on the nose and ears covered under "medical necessity" -- how are they getting away with this?
 
http://www.youtube.com/watch?v=odA5MHC3lCw

we can just expect more of this crap after all the NIH funding that has been given to the likes of Cordon-Cardo. More garbage and unregulated testing that tells you nothing but costs patients thousands of dollars giving everyone a major headache and projectile vomiting at the site of these *****s that are running pathology and sound science, and scientific and medical research into the ground.

I did a research project on prostate cancers and testing and found that his work is simply bogus and could not even utilize it in my paper. IT'S GARBAGE.
 
Last edited:
MOHS_01 said:
Interesting -- I have to argue not infrequently with payers (well, mostly Medicare) to get biopsy proven recurrent 2cm carcinomas with aggressive features on the nose and ears covered under "medical necessity" -- how are they getting away with this?
Click to expand...

They talk the payers into it somehow. It's women health afterall, the biggest consumers. A lot of medically unecessary procedures are done for that group. If you challenge it, the protestors are out in force saying its a war on women.

And now we get to pay for their birth control.
 
WEBB PINKERTON said:
They talk the payers into it somehow. It's women health afterall, the biggest consumers. A lot of medically unecessary procedures are done for that group. If you challenge it, the protestors are out in force saying its a war on women.
Click to expand...

What sorts of testing do you consider unnecessary?
 
LADoc00 said:
Dear Lord! Some of those rates are like 25% Medicare!!!

Im not even sure that is legal....at least in California. The law here disallows rates essentially below state Medi-Cal levels, which those well are.

NOTE: Everyone should pre-emptively exit Aetna's provider network. We cannot allow this to stand. This is an outrage.
Click to expand...

Can you please reference the California State Laws which keep reimbursements from falling below Medi-Cal levels?
 
Maybe it is Aetna's goal to have everyone get rid of their contracts, so they can be exclusive with Quest, their "preferred lab".
Are people having issues with Aetna directing their patients towards Quest?
 
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