Aetna, health insurer to about 440,000 people in the Tampa Bay area, has notified the Pinellas County School system and other employers that BayCare Health System hospitals may drop out of its network as of January.

That's worrisome, says Ted Pafundi, head of insurance for the school system. Aetna insures about 25,000 employees and their families.

Morton Plant, Mease and St. Anthony's hospitals in Pinellas and St. Joseph's and South Florida Baptist hospitals in Hillsborough are highly regarded members of the BayCare network. Residents of upper Pinellas County, in particular, would have no network hospital between Largo Medical Center and Helen Ellis Hospital in Tarpon Springs if BayCare hospitals drop out.

On the other hand, brinkmanship is not uncommon when insurance companies and health care providers renegotiate multi-year rates, which BayCare and Aetna are doing for 2009. The school system has experienced similar showdowns in the past when Cigna and Humana had the schools' contract, Pafundi says.

Pafundi, union chief Jade Moore and Aetna spokesman Walt Cherniak all say they are optimistic that the two sides will cut a deal before Jan. 1, avoiding any interruption of service.

"We want to give our members at least 30 days of notice before any potential expiration of an agreement,'' Cherniak says. "It's not unusual in the course of hospital negotiations to come up relatively close to deadline and have a termination notice on the table as we continue to talk.''

Cherniak declines to discuss specific numbers, as does Isaac Mallah, a BayCare executive who negotiates managed care contracts.

But Mallah says Aetna is asking for payment rates below the market rate for other large insurers, like Blue Cross and Blue Shield of Florida and UnitedHealthcare.

If Aetna doesn't pay the market rate, Mallah says, then "everybody else who uses BayCare hospitals ends up subsidizing Aetna, which we don't think is tenable.''

If the sides fail to reach agreement, he says, Aetna members can still use BayCare hospitals in emergencies. Also, pregnant woman can pre-register before the end of year to have their delivery at BayCare hospitals and Aetna will pay, regardless of whether the two sides reach a contract.

-- Stephen Nohlgren, Times staff writer