NewYork-Presbyterian Hospital and health care providers across the Hudson Valley could soon be considered out-of-network for patients with Aetna health plans.
The changes will take effect from April 1, unless a new health insurance coverage agreement is reached by March 31. Hospitals that could be affected include NewYork-Presbyterian Westchester Hospital (formerly Lawrence Hospital) in Bronxville and Hudson Valley Hospital in Cortland, as well as affiliated medical institutions. Group and the Behavioral Health Center of White Plains, according to a letter the health system is sending to patients about ongoing contract negotiations.
Potential out-of-network transition would force Aetna customers to increase their medical costs or seek alternative in-network providers at more than 19 NewYork-Presbyterian facilities throughout the New York City metropolitan area However, it is the latest one. An example of New Yorkers being harmed when contract negotiations between a medical provider and a health insurance company break down.
Earlier this year, the WellNow Urgent Care site in upstate New York discontinued Excellus BlueCross BlueShield coverage in its network.
Healthcare contract conflicts in the Hudson Valley over the past decade have involved similar disputes over coverage and reimbursement rates between various health plans and hospital networks. The risks increase as the cost of providing health care in New York State continues to rise and the crisis within the state’s health care system continues to grow due to a national shortage of health care workers.
Why did contract negotiations between New York, Presbyterian and Aetna stall?
Aetna’s contract negotiations with New York-Presbyterian focused on how much Aetna would pay the health system’s hospitals and medical practices for the care provided to Aetna members. The agreements being negotiated relate to several areas of Aetna’s business, including employer-sponsored organizations, professional employment organizations, and Medicare Advantage health plans, a health system listed on its website.
The health system argued that it began negotiations with Aetna well before the contract end date of March 31. “So far, Aetna has offered an unreasonable offer,” the health system said in a statement posted online to patients, without providing further details.
Contractual disputes: WellNow Urgent Cares is ending coverage of its network Excellus in New York.What you need to know
NewYork-Presbyterian added: “We look forward to Aetna continuing good faith negotiations to reach a reasonable offer that puts patients first.”
In a statement to the USA TODAY Network on Monday, Aetna said the health system is demanding that Aetna health plan sponsors “substantially increase reimbursement rates that are unsustainable and would result in substantial cost increases.” Because of this, he claimed that there is currently a “significant divergence in conditions” from New York Presbyterianism. And the members.
Aetna remains “committed to negotiating in good faith toward a fair contract,” the statement added.
The exact number of Aetna customers currently using NewYork-Presbyterian’s services is unknown, although the insurer covers more than 1.8 million patients across the New York City metropolitan area. city record show.
According to , the health plan has the third-largest commercial market share in the nation and covers tens of millions of patients nationwide. american medical association.
Aetna out of network: How much is the price increase?
If contract negotiations fail, Aetna customers who had hoped to contract with NewYork-Presbyterian providers could face out-of-network costs that could add thousands of dollars to their medical costs. According to Aetna’s website.
For example, if an Aetna member who requires a five-day hospital stay uses an in-network provider, he or she may have to pay $1,750 in copays. The health insurance company says in its customer information document that the hypothetical cost for an out-of-network hospital would jump to $19,750.
For outpatient surgeries, the difference in estimated patient costs increased from $120 with an Aetna network provider to $1,040 with an out-of-network provider, records show.
Providers at ColumbiaDoctors and Weill Cornell Medicine, regardless of office location, will not be immediately affected by the April 1 contract expiration, the health system noted. Their care will be provided to Aetna customers in-network through May 31, regardless of the outcome of contract negotiations.
