05/09/2023

NYC Retirees Aetna Medicare Advantage Plan-Fee Schedule, Claims and Covered Services

Regarding the NYC retirees Aetna Medicare Advantage plan- is there any information on fee schedule, claims policy, covered services etc? I am concerned that the fee schedule is roughly 50% of traditional Part B Medicare for existing Aetna Medicare enrollees. In addition, 59 modifier denials are another concern that does not exist for traditional Medicare. Is the Association taking any steps to protect it’s members from a 50% pay cut with constant claim denials? Many of us that practice in NYC will be affected by this changeover. Thank you for any guidance.

There is no specific information from Aetna on how coverage for the NYC retirees will be different than any of their other Medicare Advantage Plans. The reimbursement and coverage for routine podiatry services should be the same as any individual or group Medicare Advantage Plan. If there are any major differences, it should be communicated prior to the plans becoming effective in September 2023. We cannot speak on any action at this time being taken by the NYSPMA regarding multiple surgery reduction issues and denials that are causing charges to be reimbursed at lower rates compared to FFS Medicare.