A PROVIDER EXPERIENCE
Jennifer Lindsay, Washington
INSURER(S) / Agency: AETNA
Aetna denied coverage for massage therapy on the basis that they don’t cover it if it is performed by a massage therapist. The client has massage therapy coverage on her plan. I sent a letter of appeal, quoting part of Section 2706, and this was the response:
“We have received your request for reconsideration of services. This letter is in response for your request for reconsideration of services rendered on for the member listed above. We are upholding our original decision. Following our review, we have determined that the claim in reference was processed correctly to denied .since,Covered services do not include expenses for these services when delivered by certain providers (e.g., Dietitians, Nutritionists, Acupuncturists, Naturopaths, Massage Therapists). You may bill the member for these services.” (Typos are theirs).
I am a licensed health care provider in the state of Washington, contracted with Aetna, and it is within my scope to perform massage therapy. It seems to me that they are illegally denying reimbursement for services rendered to this client, (which should be covered) based upon Section 2706 of the Affordable Care Act. I am going to continue pursuing this, as their actions are against the law.
Submitted: Jan. 1, 2016
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