Contract fight always an anxious time for patients

Print Friendly and PDF By: Andy Miller Published: Jan 21, 2014

Contract battles between hospitals and insurers are often fought right up to the deadline for a deal.

The typical scenario is that during the last month a contract between a health insurers and a health system is in effect, both sides announce publicly that the agreement is about to expire. The pressure builds on the negotiating parties.

Consumers get caught in the middle, fearful that they won’t be able to go to their usual doctors and hospitals.

pieddThese disputes generally get worked out in time, but often mere hours before the old deal expires.

Such a conflict is now occurring, pitting Piedmont Healthcare against insurers Aetna and Coventry. The contract expires at the end of January.

Piedmont spokeswoman Diana Lewis said Tuesday that the health system, which includes Piedmont Hospital in Atlanta’s upscale Buckhead neighborhood, remains committed to working out a solution.

“It is not unusual for an agreement to be reached at the last minute,’’ Lewis said in a statement. “We are working diligently to renegotiate this contract on behalf of our five hospitals and physicians without creating undue anxiety or worry for our patients.”

Aetna recently acquired Coventry, and between the two of them they have more than 600,000 members in Georgia.

Aetna spokesman Walt Cherniak said Tuesday that the company was required to send notification letters 30 days from the contract’s end, informing members of the possibility of a termination.

“But we have been in regular discussions and negotiations with Piedmont, and we are very hopeful we’ll be able to reach agreement on a new contract before that date,’’ Cherniak said Tuesday.

Three years ago, in fact, Piedmont and Aetna reached an agreement on a new three-year contract just hours before a midnight deadline.

If a deal is not reached by the end of the month, many Aetna members will already have had to choose a new physician or pay a much higher cost for out-of-network services delivered by Piedmont’s hospitals or doctors.

Piedmont has four hospitals besides the one in Atlanta: Piedmont Fayette Hospital, Piedmont Henry Hospital, Piedmont Mountainside Hospital (in Jasper) and
Piedmont Newnan Hospital. The contract also includes the 1,000 physicians in the Piedmont Clinic, Piedmont Physicians Group and Piedmont Heart Institute Physicians.

Both Piedmont and Aetna have waged high-profile contract battles in the past.

Piedmont and Blue Cross and Blue Shield of Georgia wrangled in 2006 in a contract dispute that played out in advertising and the media. An agreement was reached, but not until about a month after the previous contract had ended. The delay caused many patients to look for new doctors.

Aetna and Atlanta’s Northside Hospital clashed over contract restrictions before a deal was struck in 2001. Aetna had objected to Northside’s deals with insurers that excluded other hospitals in exchange for lower prices. The 2001 accord dropped the exclusivity provision, and Aetna agreed to pay ‘‘premium pricing’’ to Northside.

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