Can You Help Me Get A Contract With Aetna?

Question

I am the Office Manager for a hospice in Atlanta. I have successfully obtained contracts with several insurance companies such as United Healthcare - but cannot seem to get Aetna to cooperate with me. The type of contract that I need is a Provider Contract (putting our company into the "preferred providers" pool). I've gone through Provider Relations and every other outlet I could think of but still have no contract.

If anyone has ANY ideas or possibly even has a foot in the door with Aetna and is willing to help me out, I would really appreciate hearing from you!

Thanks :)

Answer 1

Becoming a preferred provider for Aetna means you must meet their credentialing and licensing requirements AND there must be a need for the type of service you want to provide in your area. Here is a link to Aetna's page on becoming a provider and FAQ's.

http://www.aetna.com/provider/medical/jo...

I suggest submitting an application and they will respond also in writing.

Answer 2

You've tried all the appropriate outlets - you'll just have to keep following up every few months to see if they have an opening.

How many other hospice locations are contracted in your geographic area?  

You have to remember that not everyone in an area is able to have a contract - that's the whole point of a "preferred provider network."  The in-network providers discount their rates in exchange for receiving the increase in patient volume from the contract, because patients are being steered to them vs. the competition.

If the market for hospice is saturated in your area, then it will be very difficult for you to get a contract.  Contracts for ancillary services are generally lower priority for contracting staff as it is (as opposed hospital and physician contracts).  If Aetna feels that they have decent market coverage in your area for hospice services, then they probably wouldn't feel like its worth the time/effort to do all the negotiations and credentialing for you to have a contract.  Sorry.

(If there *aren't* a lot of hospice providers in your part of the city, that's how you should go about marketing your services...an insurer is more likely to take the time to contract with you if you fill a gap in their coverage area.)