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Aetna, AMA clash over Medicare payments.(Practice Trends)

Aetna Inc. said in January that it is working with the American Medical Association and state medical societies to resolve issues involving nonparticipating physicians after the AMA complained that the insurer was paying those physicians just 125% of Medicare rates and then telling patients they didn't need to pay the rest.

In a letter sent to Aetna, Dr. Michael Maves, AMA's chief executive officer and senior vice president, noted that Aetna's policy--implemented last June--fails to take into account different practice costs that are reflected by physicians' billed charges.

"It is simply arbitrary and capricious for Aetna to deem 125% of Medicare to be a fair payment ...

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