Medicaid insurer Aetna on even thinner ice with state officials

TOPEKA — Aetna remains in hot water with the state of Kansas, which recently threatened to cancel the company’s Medicaid contract.

In late July, the Kansas Department of Health and Environment gave Aetna Better Health 10 days to resolve a laundry list of long-running problems.

But on Tuesday, the agency said the insurer’s reply doesn’t cut it, “nor does it present a clear path to compliance.”

Aetna gets another shot at fixing what health care providers describe as chronic issues with payment, among other concerns.

Aetna provides health insurance to around 100,000 Kansans under KanCare, the state’s privatized Medicaid system. It’s one of three companies with contracts to do so, and replaced one of the previous insurers in January.

The state health department did not provide a copy of Aetna’s compliance plan, explaining it is not yet a public document in its current unfinalized state. But in a cover letter that Aetna filed with the state on Aug. 7, says the company says it has fixed several issues and that many of the other problems “are well on their way to compliance.”

State health officials plan to meet with Aetna leaders, who asked in their letter for an in-person conversation in the event that Kansas remains unsatisfied. As for setting a new deadline for Aetna, officials intend to meet with company leaders first.

Read our original story on complaints against Aetna, and on the state’s demands

Complaints against Aetna include that the company doesn’t reimburse correctly or on time. Providers say they sometimes don’t get paid because Aetna demands advance permission for certain basic procedures. They also complain that the company hasn’t put together a complete directory of physicians and specialists that it covers.

The state’s written complaint to Aetna in July said that doctors and others struggle to secure provider credentials from the insurer, and that discrepancies in Aetna’s records mean Kansas can’t judge the adequacy of the company’s provider network for Medicaid recipients.

Aetna didn’t grant requests last week and this week for interviews, but said in an email that it will work with Kansas to “enhance” its corrective plan and “add a greater level of detail.”