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Aetna and BayCare hospitals far apart on contract

Aetna, health insurer to about 300,000 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, Ted Pafundi, head of insurance for the school system, said recently. 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 northern Pinellas County, in particular, would have no network hospital between Largo Medical Center and Helen Ellis Memorial 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 said.

Pafundi and Aetna spokesman Walt Cherniak said they were optimistic that the two sides will cut a deal before Jan. 1, avoiding any interruption of service.

"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 said.

Isaac Mallah, a BayCare executive who negotiates managed-care contracts, said Aetna is asking for payment rates below the market rate for other large insurers, such as BlueCross BlueShield of Florida and UnitedHealthcare.

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

Last week, BayCare upped the ante by sending out notices to patients about the impasse and suggesting that they contact Aetna to complain.

"You and your family could be forced to receive care at another hospital that you don't know or trust," the letter said. "This is not the health plan coverage your employer purchased from Aetna, and not the one you should settle for. Aetna needs to know that people will not be deprived of quality care."

Cherniak said Tuesday that BayCare is asking for a 30 percent increase over three years.

If the sides fail to reach agreement, Mallah said, Aetna members can still use BayCare hospitals in emergencies.

Also, pregnant woman can preregister before the end of year to have their delivery at BayCare hospitals and Aetna will pay, regardless of whether they settle.

Times staff writer Kris Hundley contributed to this report.

Aetna and BayCare hospitals far apart on contract 12/03/08 [Last modified: Wednesday, December 10, 2008 5:43pm]
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