Tens of thousands of New Yorkers who got insurance through Aetna could lose their insurance. 10 New York Presbyterian Hospitalstwo large physician networks and their array of specialty clinics will open in the coming months, with some types of care likely to go out of network on April 1st.
The insurance giant and the hospital system are negotiating a contract through the end of this month, but no agreement has yet been reached. Both sides blame the other for the current situation.
Aetna spokesman Alex Kepnes said, “We believe there is a gap in the terms of the current discussions, with NewYork-Presbyterian demanding a significant increase in reimbursement rates, which is unsustainable.” “This would substantially increase costs for health plan sponsors and members,” said Aetna spokesperson Alex Kepnes. said in a statement this week. “We remain committed to negotiating in good faith for a fair contract.”
NewYork-Presbyterian spokeswoman Angela Karafazuli said in a statement that the hospital network was working “around the clock” to negotiate an agreement by the end of March, but added, “So far, Aetna has “They are presenting unreasonable proposals that endanger lives,” he added. our ability to provide the best care; ”
Neither party has said exactly how many patients will be affected if the contract is not renewed, but Karafazli said it would be “tens of thousands.”
NewYork-Presbyterian is known for its top academic medical centers, including Weill Cornell Medical Center on the Upper East Side and Columbia University Irving Medical Center in Washington Heights. We also operate neighborhood hospitals such as Brooklyn Methodist and specialty facilities such as Morgan Stanley Children’s Hospital and Westchester Behavioral Health Center.
If negotiations fail, NewYork-Presbyterian Hospital will be removed from the Aetna member network on April 1, but patients will still receive emergency care. Outpatient care at ColumbiaDoctors or Weill Cornell Medicine network providers will no longer be in-network for Aetna members on July 1st. Each of these physician networks includes more than 1,800 clinicians.
Patients who are pregnant or receiving treatment at NewYork-Presbyterian should contact Aetna to determine whether they can retain coverage for an additional 90 days under state and federal laws governing continuity of care. is needed.
New York Presbyterian Church Website give advice to the elderly If you are enrolled in one of Aetna’s Medicare Advantage plans, you plan to change your insurance provider during the current Medicare Advantage open enrollment period, which ends March 31st. However, many Aetna members obtain health insurance through their employers, making it difficult to simply choose another insurance company.
Late last month, the NewYork-Presbyterian Church sent a letter to patients advising them to “discuss with their employers whether there are alternative health plan options available to them.”
This is the second time this year that thousands of New Yorkers are at risk of losing their current health care provider due to a business dispute between a major health insurance company and a major hospital network. Many New Yorkers with United Healthcare plans are also looking for new doctors after the insurer terminated its contract with Mount Sinai Health System over proposed rate increases.
Recent medical industry consolidation has brought many of the region’s health services under the umbrella of just a few large hospital networks, including NewYork-Presbyterian Hospital and Mount Sinai Hospital. Health policy experts say this would give these providers more power to negotiate prices. However, the risk also increases if the insurance company decides to withdraw from the contract.
Patients pay the price as hospitals and insurance companies “battle”
Krutika Amin, a health care cost expert at the health policy nonprofit KFF, said “fights between providers and plans” over payment rates are not uncommon.
If insurers want to lower premiums for patients, they must appear willing to come off the negotiating table, Amin added. But he said insurers often end up acquiescing to price increases proposed by large hospital networks to ensure their customers get coverage from the providers they want.
Industry consolidation has resulted in fewer hospital networks, and those that remain have become larger and larger. According to KFF, this process often leads to higher medical costs, in part because large networks have the power to demand higher rates from insurance companies. research summary.
But insurers across the country are increasingly threatening to eliminate hospital networks over proposed price hikes. The Wall Street Journal reported. Many hospitals say they need to increase salaries to cover increased staffing costs and other expenses.
Splitting hospital networks and insurance companies can disrupt patient care and limit options. Leticia Negron, who lives near Brooklyn Methodist Hospital in Park Slope, said all of the doctors are currently affiliated with the neighborhood and NewYork-Presbyterian Network.
“I reached out to my internist to try to get an appointment before the end of the month, but they were all fully booked because obviously everyone was trying to get an appointment,” Negron said. “I was put on the waiting list.”
Negron said he received a Feb. 26 letter from NewYork-Presbyterian informing him of a possible breakup with Aetna, but he has not yet heard anything from the insurance company.
Aetna did not respond to a request for comment on whether it alerted members to the potential change in coverage.
This article has been updated to correct the dates by which outpatient services in the ColumbiaDoctors and Weill Cornell Medicine systems may fall out of network for Aetna members.
