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Aetna Tightens Reimbursement Policies for Hospital “Never Events”

Modern Healthcare reported, Aetna has “established new, tighter policies” to constitute whether it will pay for “medical care related to errors made by providers.” Under the policies, Aetna has “broken errors into two categories: ‘never events’– three events involving surgery: wrong patient, wrong site and wrong procedure — and 25 serious reportable events as defined by the National Quality Forum. Providers will not be reimbursed for a case involving one of the three never events.” Of the 25 reportable events, “eight will be reviewed by Aetna to determine whether reimbursement should be withheld.” The rest of the events will also be reviewed, “but they will not be considered eligible for adjustments to reimbursement,” an Aetna spokesperson explained. Additionally, Aetna will require providers to also “report the errors to the Joint Commission, a state reporting agency, or a patient-safety organization.”

From the American Association for Justice news release.

Bob Kraft

I am a Dallas, Texas lawyer who has had the privilege of helping thousands of clients since 1971 in the areas of Personal Injury law and Social Security Disability.

About This Blog

The title of this blog reflects my attitude toward those government agencies and insurance companies that routinely mistreat injured or disabled people. As a Dallas, Texas lawyer, I've spent more than 45 years trying to help those poor folk, and I have been frustrated daily by the actions of the people on the other side of their claims. (Sorry if I offended you...)

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