Tuesday, February 4, 2003

Health Alliance to cut Aetna patients

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.

E-mail tbonfield@enquirer.com

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