Tens of thousands of New Yorkers insured through Aetna could lose coverage for New York-Presbyterian’s 10 hospitals, two large physician networks, and its array of specialty clinics in the coming months — with some types of care potentially going out of network on April 1.
The insurance giant and hospital system are trying to negotiate a contract by the end of the month and have yet to reach an agreement. Both sides are blaming the other for the current situation.
“At this time in our discussions, we believe we are far apart on terms because New York-Presbyterian is demanding significant increases in reimbursement rates that are unsustainable and will materially raise costs for our health plan sponsors and our members,” Aetna spokesperson Alex Kepnes said in a statement this week. “We remain committed to negotiating in good faith for a fair contract.”
New York-Presbyterian spokesperson Angela Karafazli said in a statement that the hospital network is committed to negotiating “around the clock” to reach a deal by the end of March, but added that “so far, Aetna has presented an unreasonable offer that would jeopardize our ability to provide the best care.”
Neither party would say exactly how many patients would be affected if they fail to renew the contract, though Karafazli said it would be “many tens of thousands.”
New York-Presbyterian is known for leading academic medical centers like Weill Cornell Medical Center on the Upper East Side and Columbia University Irving Medical Center in Washington Heights. It also runs neighborhood hospitals like Brooklyn Methodist and specialized facilities like the Morgan Stanley Children’s Hospital and the Westchester Behavioral Health Center.
If the talks break down, New York-Presbyterian hospitals will go out of network for Aetna members on April 1, but patients will still be covered for emergency care. Outpatient care at medical practices in the ColumbiaDoctors or Weill Cornell Medicine networks would go out of network for Aetna members on July 1. Each of those physician networks encompasses more than 1,800 clinicians.
Patients who are pregnant or receiving treatment at New York-Presbyterian should contact Aetna to find out if they can retain their coverage for another 90 days under state and federal laws governing continuity of care.
New York-Presbyterian’s website advises older people enrolled in one of Aetna’s Medicare Advantage plans to switch insurers during the current Medicare Advantage open enrollment period, which goes through March 31. But many of Aetna’s members are enrolled in health plans through their employers, making it difficult to simply choose another insurer.
New York-Presbyterian sent a letter late last month that advised patients to “talk to your employer today to see if there are alternative health plan options available.”
This is the second time this year that a business dispute between a large health insurer and major hospital network threatens to force thousands of New Yorkers to lose their current health care providers. Many New Yorkers enrolled in UnitedHealthcare plans are also looking for new doctors after the insurer ended its contract with Mount Sinai Health System, citing proposed rate hikes.
Consolidation in the health care industry in recent years has led many of the region’s health services to come under just a few large hospital networks, including New York-Presbyterian and Mount Sinai. That’s given these health care providers more power to negotiate prices, according to health policy experts. But it’s also raised the stakes if an insurer decides to walk away from a deal.
Patients pay the price as hospitals and insurers ‘tussle’
A “tussle between providers and plans” over payment rates is not uncommon, said Krutika Amin, a health cost expert with health policy nonprofit KFF.
If insurers want to keep patients’ premiums down, they have to appear willing to walk away from the negotiating table, Amin added. But insurers often end up acquiescing to price hikes proposed by major hospital networks to ensure they cover the health care providers their customers want, she said.
Consolidation in the industry has resulted in fewer hospital networks, and the remaining ones have grown larger and larger. That process often leads to higher health care prices, in part because large networks have the power to demand higher rates from insurers, according to a KFF research brief.
But insurers across the country are increasingly threatening to drop hospital networks over proposed price hikes, the Wall Street Journal has reported. Many hospitals say they need to get paid more to cover rising labor and other expenses.
A split between a hospital network and insurer can disrupt patients’ care and narrow their options. Leticia Negrón, who lives near Brooklyn Methodist Hospital in Park Slope, said all her doctors are currently in the neighborhood and the New York-Presbyterian network.
“I reached out to my internist to get an appointment by the end of the month, but they were all booked up because obviously everyone’s trying to get in now,” Negrón said. “I’ve had them put me on a waiting list.”
Negrón received a letter from New York-Presbyterian, dated Feb. 26, that informed her about the potential split with Aetna, but said she still hasn’t heard anything from the insurer.
Aetna did not respond to a request for comment about whether it has warned its members about the potential change in coverage.
This story has been updated to correct the date when outpatient care for the ColumbiaDoctors and Weill Cornell Medicine systems could go out of network for Aetna members.