04/25/2022 - Recognizing the impact on access to RDNs' services and financial sustainability of nutrition practices, the Academy was dismayed to learn about the recent changes in Aetna's reimbursement policy for RDNs' services under its commercial plans.
The Academy has reached out to Aetna and to other professions affected by the policy change. Below is additional information on the issue, actions RDNs can take and further actions planned by the Academy.
Q: Why did Aetna revise its policy?
A: Aetna states the policy was revised as part of an overall strategy to expand its RDN provider network to meet increased demand for nutrition counseling services by members and employers. Specifically, Aetna wants to do more contracting with independent RDNs such as outside hospital outpatient clinics.
Q: Which professions are affected besides nutrition and dietetics?
A: The policy revision also includes audiologists, genetic counselors, massage therapists and respiratory therapists, based on increased demand for their services and plans to expand those provider networks as well.
Q: Who is affected by this policy?
A: While the initial impact is being felt in Northeast states, it is a national policy that will be implemented over time due to state laws, eventually affecting the entire U.S. The reimbursement policy applies to all fully insured and self-funded commercial plans.
Q: What is the Academy doing to help members with this issue?
A: The Academy has conveyed the following to Aetna:
- We are concerned that the policy will not help Aetna achieve its stated goals; rather, it will likely decrease consumers' access to RDNs and prevent existing and new independent RDNs from participating in the provider network.
- We shared information on the value of MNT provided by RDNs from the health plan’s perspective.
- MNT by RDNs should be on a menu of options offered to health plan members.
- We suggested positioning RDN payments at a level on par with Medicare: 85% of physician payment rates.
- The Academy urged Aetna to work with us to develop future policy decisions related to access to nutrition care and RDNs.
Q: What can I do?
A: Negotiate, negotiate, negotiate!
- Individual RDNs: Contact your provider services/relations representative and ask to renegotiate the rates in your individual provider agreements. According to Aetna, the company's staff in all markets have the flexibility and tools needed to negotiate rates and deviate from the policy.
- If you do not know who your provider services/relations representative is, call Aetna's Provider Contact Center at 888/632-3862.
- Remember that negotiation must be done by single entities, such as individual RDNs or businesses. Legally, RDNs cannot band together to negotiate rates with commercial payers.
- The Academy's website contains information on setting fees and negotiating with commercial payers.
- Report the results of your negotiations to the Academy. We will use the information to inform further actions.
- Manage your payer mix. All ambulatory health care providers make decisions on how many clients from each payer source to include on their patient panel at any point in time. RDNs can and should do the same. Balance variable payment rates and revenue streams to achieve your financial goals.
Q: Should I pull out of Aetna's network?
A: RDNs need to evaluate this option from your own individual or group practice perspective. Take into consideration your cost of doing business and other considerations such as the insurance market in one's geographic area. Aetna's revised policy also applies to reimbursement rates for non-participating providers.
In conclusion: the Academy's commitment to you
The Academy will continue to advocate with Aetna for fair reimbursement policies that support consumer access to RDNs in all practice settings. We will also hold Aetna accountable to its stated commitment to building their RDN provider network and opportunity to negotiate contract rates. While the Academy cannot legally negotiate rates with commercial payers on behalf of RDNs, we can advocate in general for reasonable policies.
We will continue to provide you with updates. Let's each do our part to effect change and please encourage your colleagues to join the Academy today!