More Financial Challenges for Pathology Practices in Michigan

December 5, 2005

Effective January 1, 2006; PPOM’s network in Michigan will replace Aetna’s networks for most Aetna plans and products. PPOM was acquired by Aetna as part of HMS Healthcare purchase. In July 2005, Aetna completed its acquisition of HMS Healthcare, the parent organization of the PPOM and Flora Health Networks. If you are participating with PPOM, you will now be paid the PPOM rate for all of your Aetna patients. This may cause a payment decrease as typically Aetna was paying more per 88305-26 then PPOM.

We have also discovered Connecticut General Life Insurance Company (CIGNA) and Health Alliance Plan of Michigan (HAP) have formed a marketing affiliation to jointly offer a suite of open access products to companies with operations in Michigan and other states. The products will be offered through CIGNA and HAP’s subsidiaries; Preferred Health Plan Inc., Alliance Health and Life Insurance Company.

Many practices are looking at other options to stop this network shifting that leads to declining revenue. Vachette Pathology is helping nine separate practices in Michigan to re-negotiate their managed care plans and actually increase their revenue.

For further information, please contact Mick Raich

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