Amicus brief seeks to provide relief from Aetna’s ‘level of severity’ policy

The AHA filed an amicus brief June 5 in the U.S. District Court for the Eastern District of Pennsylvania in support of a provider seeking to obtain declaratory or injunctive relief from Aetna's "level of severity" reimbursement policy. The policy, effective since January, is a new type of reimbursement for "low severity" inpatient stays that the company said will be "comparable" to observation rates. "Unexpected changes to an insurer's policies not only affect the hospital's finances, but also increase a hospital's administrative burden," the AHA wrote. "Billing for medical services already requires large teams of professionals who must follow requirements that vary from insurer to insurer. When an insurer changes a policy mid-contract, hospitals cannot easily absorb the change overnight."

The AHA last year urged Aetna to rescind the policy, saying that it "could erode the transparency consumers rely on to make informed decisions about their care, undermine important regulatory protections that safeguard patients' coverage, and jeopardize the ability of hospitals to provide high-quality, accessible care to all who need it."