Aetna Exchange Policies Reimburse Lower Than Standard Commercial Plans

NC, if that matters. Is this even legal? I’ve been trying to get Aetna to provide a fee schedule for Exchange plans for over a year now but they are still proving incapable of producing one, if it exists. No other insurance company that provides Exchange policies in my state (BCBS, UHC, Cigna) have separate reimbursement rates for Exchange policies.

For example, we receive $77.90 for 92507 from standard Employer/other Commercial policies but only $69.78 from Exchange policies. I can’t find anything stating whether this is allowed or not, nor can I find any other provider complaining about it?

Does anyone have any insight into the situation and whether it’s legal according to the ACA or not? And if it IS legal, is this refusal to be transparent about pricing and provide a fee schedule normal? I’ve had no issue getting the fee schedule for standard commercial policies. We are in-network with their exchange plans as well, so this isn’t just an in/out of network reimbursement difference. Is it ombudsman time? Can we even do an ombudsman on a commercial insurance carrier? We’ve only done them on NC Medicaid, so this would be entirely new territory for us.