Aetna Inc.’s health-pay dispute with a North Carolina hospital operator has spilled into the courts despite active talks between the Hartford health insurer and Novant Health toward a resolution, authorities said Wednesday.
Novant Health, parent of the Presbyterian network of hospitals and medical clinics serving about 5 million people in the Carolinas and Virginia, last week sued Aetna in Mecklenburg County, N.C., the Charlotte Observer reports.
At issue is a new contract to replace one that expires July 1 for which the Winston-Salem-based health system is seeking higher reimbursement rates that Aetna won’t agree to.
Their dispute went public three weeks ago, when Aetna warned some doctors in Novant’s network that they may have to admit patients to other hospitals if it cannot reach a new contract with Novant.
The Observer reports both sides said Tuesday they hope to negotiate a contract by June 30.
Aetna spokeswoman Cynthia Michener confirmed both parties met again Wednesday.
“We continue to talk or email daily,” Michener said.
Aetna says Novant wants a 12 percent increase on top of the scheduled 7.7 percent rate increase it got in January. Aetna said the 12 percent hike would include a 6.9 percent rate increase for its greater Winston-Salem market that includes Forsyth Medical Center, Medical Park Hospital and Thomasville Medical Center.
Aetna 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.
The suit alleges that Aetna threatened to terminate doctors’ ability to treat Aetna patients unless those doctors agreed to send patients to hospitals operated by Novant competitors, the newspaper reports online.
Meanwhile, the suit says, the insurer purposefully failed to inform doctors and patients that members may request that Aetna continue to provide in-network coverage for 90 days after the contract ends.
Novant is asking the court for injunctive relief and damages, including attorneys fees.
The suit, Novant said, stems from Aetna’s “attempt to gain leverage” in the contract negotiations. Novant alleges in the lawsuit that Aetna distributed confidential financial information and made false and misleading statements, such as calling the health care system the most expensive in the state, to doctors, patients and the press. Those claims damage the system’s reputation – not to mention its competitive edge with other insurers, the suit says.
Michener said Wednesday Aetna is disappointed Novant sued — but that the insurer will “vigorously defend” itself in court.
“Novant is putting its patients, who are our members, in a difficult position,” Michener said in a statement. “… Aetna continues to have significant concerns regarding the impact that Novant’s requested price increases will have on the cost of health care for Aetna’s customers, their employees and families in the Carolinas.”
