Important Information for Patients with Aetna Health Insurance

By Texas Medical Center September 2, 2014

Important Information for Patients with Aetna Health Insurance

4 Minute Read

Overview

CHI St. Luke’s Health and Aetna are currently negotiating a new contract for the care we provide to Aetna commercial and Medicare Advantage members at our hospitals. Our current contract for care provided to patients with Aetna commercial health plans runs through October 22, 2014; the end date for our contract providing care to patients with Aetna Medicare Advantage health plans is December 31, 2014. We intend to resolve our negotiations and come to agreement on new contracts before these dates. However, if we do not reach agreement, CHI St. Luke’s facilities – not physicians – will be out of network for all Aetna commercial members as of October 23, 2014, and as of January 1, 2015 for Aetna Medicare Advantage members.

We have created this web page to provide patients with the most current information on the negotiations. The information is organized by the following sections:

Key Issues

CHI St. Luke’s negotiations with Aetna center on three main points:

1. Contract language and parameters. Our contract should reflect how healthcare is changing in Houston and nationally. Renewing the language in our contract will help to balance control between Aetna and our hospitals, simplify administrative tasks, and improve overall patient care.
2. Aetna’s payments to CHI St. Luke’s. We need fair-market rates to continue providing high-quality care to Aetna members. Aetna has not increased payments to our hospitals for many years, despite how our costs have continued to increase.
3. Our transplant program. We need to renew our contract with Aetna to keep our transplant program in network. Transplant patients have unique needs, and we’re committed to maintaining all Aetna members’ access to exceptional transplant care at CHI St. Luke’s.

It’s important for the community to understand that we are working diligently to reach a new agreement so that Aetna patients can continue to access care as they normally would. Our goal throughout these negotiations is to strengthen our ability to fulfill the CHI St. Luke’s promise of enhancing community health through high-quality, cost-effective care.

What This Means for You

All Aetna members are affected by these negotiations, including those with commercial (provided through an employer or purchased individually) and Medicare Advantage plans. Nothing changes right now.

Aetna commercial health plan members can continue to receive in-network care at CHI St. Luke’s hospitals as they normally would through October 22. If we do not reach an agreement by that date, CHI St. Luke’s facilities – not physicians – will be out of network as of October 23.
Aetna Medicare Advantage health plan members can continue to receive in-network care at CHI St. Luke’s hospitals as they normally would through December 31. If we do not reach an agreement by that date, CHI St. Luke’s facilities – not physicians – will be out of network as of January 1, 2015.

If you have any questions about your specific plan’s in-network benefits, the best thing to do is to call the number for customer service on the back of your Aetna insurance card.

Emergency room visits are always covered by insurance at in-network benefit levels. If you are having an emergency, please go to the nearest emergency room.

What You Can Do

Talk to your doctor or provider about your situation. If you have an Aetna commercial health plan and our contract with Aetna expires on October 22, we can help you sort through your options, including applying for Aetna Transition of Care benefits.
Consider alternative health plans. Our hospitals participate in many other major health plans, which are listed here. Talk to your HR or benefits manager at your employer, or your broker, about your options.
Inform your friends and family. All Aetna commercial health plan members are affected by these negotiations and the October 22 contract end date.

Applying for Aetna Transition of Care Benefits

Patients with surgeries or elective procedures already scheduled on or after October 23 can apply for a temporary extension of in-network benefits. Patients who are pregnant, have life-threatening illnesses, or have a disability, may also be eligible to receive a temporary extension of in-network benefits from Aetna.

To apply, please contact Aetna’s customer service by calling the number on the back of your insurance card. We recommend that you also contact your physician to ensure that you will qualify for these benefits.

Affected Hospitals and Facilities

Our negotiations with Aetna affect hospital care provided to all Aetna commercial and Medicare Advantage health plan members at all CHI St. Luke’s hospitals and facilities (listed below). Our physicians are not affected by these negotiations.

CHI St. Luke’s Health–Baylor St. Luke’s Medical Center
CHI St. Luke’s Health–Lakeside Hospital
CHI St. Luke’s Health–Patients Medical Center
CHI St. Luke’s Health–Sugar Land Hospital
CHI St. Luke’s Health–The Vintage Hospital
CHI St. Luke’s Health–The Woodlands Hospital
CHI St. Luke’s Health Diagnostic & Treatment Center–Kirby Glen
St. Luke’s Medical Group–Galleria
St. Luke’s Medical Group–Texas Medical Center
Wound Care Clinics: Patients Medical Center, The Woodlands Hospital, Kirby Glen

Contact Us

We are committed to reaching an agreement with Aetna before the contract deadlines so that you and your family can continue to rely on CHI St. Luke’s for high-quality care. If you have questions or need more information, please contact us at 832-303-8087. If you have specific questions about your health plan or out-of-network benefits, we recommend that you contact Aetna directly by calling the number on the back of your insurance card.