The two-part agreement, reached in 2009, enables members of Aetna’s commercial plans and its Medicare Advantage program to receive covered services, at in-network rates, from WellStar’s facilities and physicians throughout metro Atlanta.
Aetna provides health benefits to 600,000 members in Georgia. Those members have access to a network that includes 80 contracted hospitals and more than 9,500 primary care physicians and specialists.
But as both sides agree a renewal will be reached, the letter outlining the contract’s expiration date scared the health care benefit provider’s membership base.
“This was not a termination notice; it didn’t say these benefits were going away,” said Aetna spokesman Walt Cherniak. “We hoped that we could have got this done before the letters were sent out, but we didn’t.”
Cherniak said the federal government requires health care providers send a letter to its members within 45 days of a potential disruption of service of a network hospital. Aetna’s internal policy mandates that members of its commercial plan be notified within 30 days of a potential disruption.
“Both sides would agree that you don’t want to alarm people unnecessarily,” Cherniak said. “The letter was meant to inform, not alarm, members of the possibility, and we believe it’s a slight one, that they could be in a position to use a different hospital, choose a different primary care physician or reschedule a procedure.”
WellStar spokesman Keith Bowermaster said that while the hospital doesn’t track the number of calls from such letters, in this case, the number has been fewer than 25.
“We understand that, often times, payers (such as Aetna) have requirements built into their contracts with employers where they must notify the members of the plan prior to any network changes,” Bowermaster said. “Based on our experience across the state and country, most of these contract negotiations get worked out either prior to, or not long after, the termination date. It is more rare for a health care provider and payer to part ways.”
In this case, Cherniak said Aetna is confident that a deal will be worked out with WellStar. And while a letter of an impending expiration of contracts like these are disheartening for members of a health care plan to receive, Cherniak said the flip side is even more challenging.
“Imagine if we said, ‘You know what, we’re going to work this thing out,’ and we don’t,” he said. “You wouldn’t want to be the patient who didn’t get a letter and wasn’t informed.”
As for the Aug. 31 deadline?
“We have a very good relationship with WellStar,” Cherniak said. “We have been meeting with them on a regular, ongoing cordial basis. We are very confident we are going to get a deal done. They have been in this network for many years, and we expect them to be with us for many years to come. We’re very hopeful that we are going to be able to do this before that deadline.”
Michael J. Pallerino has reported on business news for magazines and newspapers in the Atlanta area for more than 20 years.