Providence Health & Services in Oregon was removed from Aetna's health insurance network after the two sides failed to reach a new agreement by the end of 2024.
Aetna's contract with nonprofit Catholic Health System and insurance giant Providence has expired on Dec. 31, it announced.
This means patients of Providence hospitals, clinics, and doctors who are insured with Aetna's employer-based plans or Medicare Advantage plans will have to pay higher out-of-network rates and increased out-of-pocket costs. Or you will have to seek treatment from a medical institution. different providers.
Providence said about 9,000 patients enrolled in the Aetna plan across Oregon will be affected.
Aetna said in a statement: “While discussions continue, we are unable to renew our network agreement because Providence is demanding unreasonable rate increases that will increase health insurance costs for local employers and out-of-pocket costs for our members.” said.
Providence, for its part, accused Aetna of refusing to cover rising health care costs, saying, “Other insurers have agreed to step up…but Aetna has no intention of following suit.”
Both Providence and Aetna said the outage will affect most customers in Oregon, but Providence providers in Jackson and Josephine counties will remain in-network until Feb. 17. The Renton, Wash.-based medical giant has not yet finalized a new deal with Aetna for its southern Oregon facility. It has a separate insurance contract with other facilities in the state.
The fallout comes even as Providence transitions its employees to a 2025 plan managed by Aetna.
Contract disputes between insurance companies and health care providers are becoming increasingly common across the country, with disputes centering on payment. Both sides agree that compensation for services needs to be increased, but opinions remain deeply divided over how much. These high-stakes negotiations have become a recurring battleground, with both sides fighting to protect their economic interests.
Last year, Providence came close to severing ties with Regence Blue Cross/Blue Shield over a reimbursement dispute, but managed to reach an agreement just before the deadline. Similarly, Oregon Health & Science University faced a similar conflict to Aetna. However, a new contract was signed at the last minute to avoid any confusion.
Hospitals receive increased payments from insurance companies to cover higher operating costs and offset the financial burden of providing services to Medicare and Medicaid patients, where reimbursement rates are often significantly lower than actual costs. argues that it is essential.
Meanwhile, Providence is also in the midst of negotiations with nurses and other health care providers over new labor contracts. Approximately 5,000 nurses, doctors, and other front-line workers at Providence facilities across Oregon have notified the health care system that they will go on strike on January 10th.
— Kristine de Leon covers consumer health, retail, small business, and data companies. Please contact kdeleon@oregonian.com.
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