APMA advocacy staff met with Aetna leadership as part of APMA’s ongoing quarterly discussions with the insurer. The conversation focused on prior authorization, the use of artificial intelligence (AI) and digital tools in coverage and payment decisions, and ongoing questions related to skin substitute coverage and review processes.
APMA highlighted its new position statement on podiatric physician involvement in emerging AI laws and regulations and emphasized that AI should support, not replace, physician judgment in claim and coverage determinations. Aetna reiterated that clinical denials continue to require human review, while also sharing updates on their growing use of digital tools to streamline administrative workflows and review processes.
APMA and Aetna also discussed practical issues related to denials and peer-to-peer review, including recurring modifier 25 concerns. In addition, APMA raised continued member concerns about skin substitutes. Aetna leadership indicated that they generally follow existing Medicare policy where applicable and may rely on their own clinical policy where no clear Medicare guidance exists.
Finally, APMA and Aetna discussed opportunities for continued collaboration, including APMA’s interest in providing input as prior authorization modernization efforts evolve. APMA will continue to engage Aetna on issues affecting podiatric physicians and share updates as appropriate.
Contact the APMA Advocacy Department with any questions at advocacy@apma.org.