Tens of thousands of Aetna members in Oregon will soon have improved access to hospitals and clinics within Providence, Oregon, following a new agreement between a major insurance provider and health system. This multi-year deal means that, starting December 1, Providence Health & Services will reintegrate its facilities in Portland and across the state into Aetna’s commercial plan network.
This new arrangement comes nearly a year after Aetna, a health insurance giant owned by CVS Health, pulled Providence Oregon from its network due to failed negotiations centered around rate hikes—an issue that’s been causing quite a stir in the healthcare sector.
Kathy Hughes, Aetna’s Western Regional Executive, expressed optimism in a statement, saying that “Providence will once again be a valued partner in our efforts to provide high-quality, convenient care to Aetna members in Oregon.”
However, the specifics of this deal vary across the state. While Providence will be incorporated into Aetna’s commercial network, access for Aetna’s Medicare Advantage plans will be limited; members will only have in-network access to Providence facilities in Southern Oregon.
An Aetna spokesperson didn’t reveal specific membership numbers for Oregon but mentioned that the state’s Medicare Advantage market is notably smaller compared to its commercial division. Federal data indicates that around 5,000 individuals in the tri-county area near Portland and 14,000 statewide are enrolled in Aetna’s Medicare Advantage plans.
In contrast, by the end of September, approximately 50,000 residents were covered by Aetna’s commercial insurance plans, and more than 250,000 were in self-insured plans managed by large employers, with Aetna as the administrator.
Aetna pointed out that this new agreement will also extend benefits to those members in self-insured plans. Philip Brand, a spokesperson for CVS Health, noted, “So, Oregon residents enrolled in Aetna’s self-insured plans will now have access to Providence in-network.”
