[Southsider2k12]

http://thenewsdispatch.com/articles/2010/0...3f192006481.txt

LP Hospital, Aetna try to resolve terms

By Matt Fritz
Staff Writer
Published: Wednesday, January 27, 2010 4:17 AM CST
LA PORTE — People under Aetna Health Insurance can still be treated at La Porte Hospital, but they’ll probably be paying more for it.

Since Jan. 1, La Porte Hospital no longer has been an in-network provider of Aetna Health Insurance due to a change in terms to which both parties have been unable to agree.

According to Pam Kukla, La Porte Hospital director of managed care and patient registration, the hospital recently requested a change in its agreement.

“Our intent is to remain in-network with (Aetna), and we continue in having our conversation with them to reach that end goal,” Kukla said.

As far as how individuals covered by Aetna will be affected, Kukla said it depends on how their employers have written their benefits.

For example, a procedure that might have a $100 deductible and a 20 percent co-insurance under Aetna’s in-network coverage might increase to a 30 percent or more co-insurance.

She said La Porte Hospital had hoped to resolve the issue by Jan. 1, but the date has been pushed back.

“We’re working diligently toward the goal of being a network participating provider,” Kukla said. “But it comes down to the terms. Aetna’s trying to change them.”

The agreement with Aetna had been in place for quite some time, Kukla said.

Despite its change to out-of-network status with Aetna, Kukla said, the hospital is willing to work with Aetna customers on a patient-by-patient basis to see if some of those discounts can still be applied.

“They can still come in and we can still work with them in terms of payment plans and whatever issues we can help them through until we get this resolved,” she said.

For instance, Kukla described a recent event where hospital staff worked with a woman in her third trimester of pregnancy. She no longer benefited form Aetna’s in-network coverage there, but the hospital was able to give her enough discounts to make up the difference.

Aetna explained the dispute this way in an e-mailed response:

“Up until January 1, 2010, Aetna’s members were able to access La Porte Hospital via Aetna’s agreement with a rental provider network called CHA, known in the insurance industry as a third party ‘rental network.’ Aetna did not have a direct agreement with La Porte Hospital. Aetna’s agreement is with CHA.”

Aetna’s statement continued.

“La Porte Hospital terminated its agreement with CHA for Aetna members effective 1/1/2010 with the expectation that Aetna would add La Porte Hospital to Aetna’s direct network via Aetna’s agreement with a large health system called Clarian, of which La Porte Hospital is a member. Aetna submitted a proposal to add La Porte Hospital to its network. Clarian refused Aetna’s proposal and did not provide a counter proposal.

“We would welcome back La Porte Hospital as an Aetna provider. This could be accomplished simply by La Porte withdrawing its Aetna participation termination notice from CHA.

“At this time and while La Porte Hospital remains out of network, there are other hospitals in the area able to take care of the needs of our Aetna members.”

[MCRogers1974]

I understand St. Anthony Memorial and the HealthPartners Medical Group are in the Aetna Health Insurance network. At least the people who traditionally use La Porte Hospital still have access to in-network health care in La Porte County.

[Southsider2k12]

http://www.thenewsdispatch.com/articles/20...10672253047.txt

Hospital, Aetna come to terms

By Matt Fritz
Staff Writer
Published: Thursday, February 25, 2010 4:18 AM CST
LA PORTE — Area residents under Aetna Health Insurance will enjoy their full benefits at La Porte Hospital starting March 1 when the hospital goes back to being an in-network provider for the company.

Pam Kukla, La Porte Hospital director of managed care and patient registration, said the hospital has reached an agreement with Aetna that will allow the two entities to provide patients with the same coverage they had before the in-network coverage ended Jan. 1. Aetna covers almost 3 percent of La Porte Hospital’s patients.

“There will be no changes, absolutely no changes whatsoever (to how Aetna patients are covered),” Kukla said. “It will be just the way it was for patients accessing us previously.”

Kukla said hospital staff during this time have been addressing concerns from employee groups and patients worried about the changes and additional costs that resulted when the split happened. Now, those worries will be eased.

“It feels like a burden’s been lifted,” Kukla said, “and that we can deliver the care to our patients without any barriers, which is why we’re here. It’s our mission.”

The hospital’s financial counselors also have been working with Aetna patients on a case-by-case basis in relation to their billing needs, since coverage has been costing them more since Jan. 1.

But Kukla said most patients weren’t interested in working out individual agreements.

“They just wanted their provider in-network so they didn’t have to worry about their out-of-pocket expenses,” she explained.

La Porte Hospital’s relationship with Aetna is via an agreement with the Community Health Association rental provider network.

According to Kukla, the hospital prompted a change in its agreement with Aetna in mid-2009, which both parties agreed to verbally. However, Aetna later requested deeper discounts from Clarion Health, of which La Porte Hospital is an affiliate. This issue was recently resolved.

The contract is an evergreen contract and will automatically renew each year unless one of the parties challenges the terms.

Kukla said the arrangement should make the hospital, insurance company and patients happy.