If the procedures you are doing are considered surgical procedures by Aetna, then that would be one reason why they want the records or op report. You have unpaid claims dating to July... why are they unpaid? Did you send the report in July, or recently, or haven't yet? Does your contract with Aetna specify how long they have to pay your claims and what happens if they exceed that, and/or does your state had a prompt pay law requiring interest if they don't pay in a timely fashion?

You should be able to send the report with the claim without waiting for the request for records; that would certainly cut down some of the delay.

Oh, and I'm not berating you, I'm trying to understand what the problem is.

Also, you may wish to reconsider your contract with any insurance company who makes it difficult to do business. See how many of your affected patients have out of network benefits, see what the requirements are (authorizations, if payments are sent to patients and not providers if out of network, etc.).



Sharon
Moderator

Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.