(Aug. 29, 2025) – Recent Aetna policy changes are causing major concern for providers and patients, particularly a new Medicare Advantage inpatient payment policy that may downgrade inpatient payments without formal denials, potentially impacting care access and provider revenue. Aetna's new "Level of severity inpatient payment policy" for Medicare Advantage, effective Nov. 15, 2025, will significantly reduce hospital reimbursement and effectively eliminate traditional appeal rights for many inpatient stays. By reclassifying coverage decisions as payment adjustments rather than denials, Aetna's policy circumvents existing appeal processes and may violate federal rules established by the Centers for Medicare & Medicaid Services. KHA submitted a
letter to the CMS Regional Office and Aetna Management asking for the policy to be reversed.
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Shannan Flach