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Letter to Aetna


The letter below was sent to Aetna's representatives on behalf of HBMA Membership from HBMA Executive Director Andre Williams and Commercial Payor Relations Committee Chair Amy Redmond:



April 21, 2016

Kimberly Marshall, MBA
Executive Director, Head of Provider Contact Centers
841 Prudential Drive
Jacksonville, FL 32207

cc: Robin Spucches
      Sr. Project Manager of Provider E-Solutions, Aetna


Dear Ms. Marshall:

We, the members of Healthcare Billing and Management Association (HBMA), request external policy guidelines or a written statement to clarify the third party billing companies contained from calling Aetna Customer Service. 

HBMA works with legislative stakeholders and federal agencies in Washington, DC to improve the business of medical billing and the practice of healthcare. HBMA is a non-profit, member-led trade association. Since its inception in 1993, HBMA and its members have encouraged personal development and adherence to the HBMA Code of Ethics, advocated on behalf of the profession, and promoted business development through a wide range of affiliated vendor resources, educational events, networking opportunities, and certification programs. The average HBMA Member has 40-50 employees, uses commercial software, has been in operation over five years, and processes about 350,000 to 400,000 claims per year.

Third party billing companies provide revenue cycle management for healthcare providers. This includes the process that manages claims processing and payment. It also entails using technology to keep track of the claims process at every point of its life, so the third party medical billing company doing the medical billing can follow the process and address any issues. This allows for a steady stream of cash flow which is vital to keep the healthcare providers financially viable. The process in its entirety includes: keeping track of claims in the system, making sure payments are collected, and addressing denied claims. The third party medical billing company is a trusted partner for the healthcare provider community, and with patients having higher out-of-pocket responsibilities to their providers, it is imperative that we resolve claims issues promptly and effectively. 

Recently, we discovered some of our members had their telephone numbers blocked by Aetna and were denied access to Aetna’s customer service for the healthcare providers they serve because they were a third party billing company. In order for our members to act on behalf of the healthcare providers we serve, they need access to customer service from Aetna. This process comes without warning given the lack of policy or rationale regarding the matter. 

We applaud the NaviNet web resource and encourage our members to utilize this service. In the past, we have partnered with Aetna several times to host educational webinars specific to NaviNet for our membership. We understand there is a feature to request a call back via NaviNet, however there still remains time when there is a need to speak to a live representative. The call back feature consistently leads to missed calls and delayed process because there is no defined practice associated with managing call backs. 

On behalf of our members, HBMA requests the healthcare providers we serve access to a live representative and formal policy guidelines regarding customer service and third party billing companies. 

If you have any question regarding this letter or Healthcare Billing and Management Association, please do not hesitate to call. Thank you in advance for your consideration and we welcome your reply. 



Andre Williams                                                                       Amy Redmond, CHBME
Executive Director                                                                   Chair, Commercial Payor Relations Committee
Direct: (202) 367-1233