Hartford health insurer Aetna Inc. is warning some North Carolina doctors that to stay in network, they may have to find a new hospital to which they can admit patients if Aetna can’t negotiate a new contract with Novant Health this summer, according to a published report.
Aetna spokesman Walt Cherniak said this week that the insurer’s Novant contract expires July 1, and the Winston-Salem-based health system is seeking higher reimbursement rates that Aetna won’t agree to, The Business Journal of Greensboro/Winston-Salem, N.C. reports on its Web site.
Novant received a scheduled 7.7 percent rate increase in January. Cherniak said the health system is seeking a 12 percent increase July 1, including a 6.9 percent rate increase for its greater Winston-Salem market that includes Forsyth Medical Center, Medical Park Hospital and Thomasville Medical Center.
Officials with Novant declined to comment on the details of their negotiations.
Cherniak said Novant is already Aetna’s most expensive system in North Carolina, with rates 51 percent above the national average and 30 percent above the state average.
“We already feel they are too expensive and can’t agree to the demands they’re making,” he said.
Bob Seehausen, a Novant senior vice president, disagrees that the health system’s rates are the highest in the state.
“We monitor cost of care very closely through independent collection sources and know that our commercial prices are below market averages,” he said.
“Aetna appears to be more interested in disparaging our health system than admitting it is willing to further restrict its members’ health care choices in order to stockpile huge profits before national health care reforms are implemented.”
Both parties said they are willing to continue negotiations.
If no agreement is reached by July 1, the roughly 1,000 Novant Medical Group doctors statewide would be considered out of Aetna’s network, and patients would therefore be charged the higher out-of-network rates for services.
But the dispute could extend beyond only those doctors employed by Novant. Cherniak said Aetna’s policy is to exclude from its network any physician who only admits at a hospital that doesn’t have an Aetna contract.
