By Tim Bonfield
The Cincinnati Enquirer
The Health Alliance of Greater Cincinnati announced Monday it plans to discontinue serving patients covered by Aetna Health Inc., effective March 1.
The Health Alliance, the Tristate's biggest health system, includes University Hospital, Christ Hospital, Jewish Hospital and Fort Hamilton Hospital in southwestern Ohio; and St. Luke East and St. Luke West hospitals in Northern Kentucky. It also represents the Alliance Primary Care physician group.
The change would most directly affect about 3,000 of Aetna's 47,000 Tristate HMO members who use Alliance Primary Care physicians. They would need to find new doctors.
It also means that about 161,000 Tristate residents covered by Aetna preferred provider organizations (PPOs) would have to pay higher, out-of-network co-payments to use Health Alliance services. "We are disappointed that the Health Alliance has terminated the contract. We have remained optimistic that through this process the Health Alliance would continue their participation in our network," said Aetna spokeswoman Karen Michlewicz.
The announcement comes after months of contract talks - including a two-month contract extension - failed to produce an agreement, said Health Alliance spokeswoman Gail Myers.
Health Alliance officials said they are willing to continue negotiations until March 1, but had to give notice to allow Aetna to send out notices to members.
Although some local hospitals have dropped health plans over rate disputes, this conflict was about "reimbursement methodology and contract language," Myers said. Different insurers use different ways to reimburse hospitals - variations that can drive up billing costs for hospitals.
"The more difficult and complex the payment methodology, the harder it is to figure out who to bill and for what," Myers said.
The Health Alliance contends Aetna's reimbursement methods were not consistent enough with other insurers.
The Health Alliance also contends that Aetna's contract expected the hospital group to comply with policies that were not spelled out in detail.
For its part, Aetna said it could not agree to a contract that would have required it to offer customized changes to its system.
TOP LOCAL HEADLINES
Schott sues in snit over seats
Letter details baseball's promises to Schott
Audit says Cincinnati wasted much of empowerment grant
Taft wants to boost spending 10 percent
Who wins, who loses in Taft budget
Health Alliance to cut Aetna patients
Complete Columbia coverage at Cincinnati.com
Peace Bell rings for astronauts
Students ponder shuttle disaster, ask why
CLIFF RADEL COLUMN
Evil wins when we don't talk
AROUND THE TRISTATE
Tax issues on special ballots today
GE grant to boost math in 2 schools
Tristate A.M. Report
Good News: Conflict put her close to God
Hometown Heroes: Howell quick to lend a hand
Obituary: Albert Neman loved learning
You Asked For It
Anderson: Send us your questions
Butler sheriff tightens property room
Hearing on Fox interchange
Bird-shooting site protested
Third charged after raid on crack house
Bicentennial Moment: WWI brought out anti-German sentiment
Teen deaths prompt forum on heroin use
New crown for Devou Park's hill
Illegal ID ring nabbed in Ky., Chandler says
McConnell has bypass surgery
Ky. molester trial requires 100 jury pool
Covington restaurant changes hands
Kenton property valuator retires
Ky. tax plan will include repeals, Patton says
Fire destroys country club built in 1840s