A New Contract Dispute Pits Aetna Against Nevada UHS: Are You Covered?

If your health insurance is with the Aetna Medicare Network, you need to read this.

I’m sure you’ll agree, that there are too many of these insurance company-medical center breakups lately. Is this the future of rate negotiations between hospitals and health insurance plans? Will it set the tone for all Medicare Advantage negotiations? I hope not. Let’s hope things will settle down after this latest coverage change. The newly announced break between Aetna and Northern Nevada Medical Group (UHS) does create a dilemma for many of our area’s Medicare members.

A Battle between Two Goliaths

UHS happens to be one of the nation’s largest providers of hospital and healthcare services. They have hundreds of hospitals and other health care centers in the U.S. In northern Nevada, there are 5. The dispute with Aetna involves Northern Nevada Medical Center, Northern Nevada Sierra Medical Center, and Northern Nevada Medical Group. The Aetna Medicare Network has covered services at those locations, but that will end at the end of the year.

Aetna’s Statement

Aetna informed us that they “will continue to pay for any covered services members receive from UHS providers at the in-network benefit level until 12/31/2022. Because of the Travel Advantage feature, this change will impact both the HMO and PPO plans in Southern Nevada as well as Northern Nevada.”

In Carson City, Washoe, Douglas, Churchill, Storey, and Lyon counties, the affected plans are HMO, PPO Select, Choice, Elite, and Eagle. Aetna says their Medicare members should receive a letter this month with information about the change. Aetna also states that they will still pay claims from UHS “at the in-network level for the remained of 2022.”

What Can You Do if You’re Affected?

Aetna says there are other local doctors in the Aetna Medicare network where their members can still access care. They have 2 ways to find doctors, hospitals, and specialists in the Aetna Medicare network:

DocFind is Aetna’s online directory. The insurance plan says it “can be used to locate other physicians in our network where members can continue to access care.” DocFind, they say, is updated six days a week. Go to this website, and click “Sign in to secure DocFind” in the upper left:  http://www.aetna.com/dse/search?site_id=bshsi

Need further assistance? You can also call Aetna Member Services. The number is listed on the back of your Aetna ID card and the calls are answered daily from 8:00 am to 8:00 pm.

Change Effective in 2023

After December 31st, 2022 Aetna may no longer provide HMO and PPO coverage for Nevada UHS-affiliated hospitals. Thousands of patients could be forced to change doctors or get stuck footing the bill beginning in 2023. For Aetna Medicare plan members, it’s disappointing news. Once we find the right doctor or provider, it’s often difficult to adjust to a change. Unfortunately, COVID-19, staffing shortages, the increasing costs of health care, and inflation have resulted in some health care instability. When it comes to contracts, it also led to a big increase in the cost of doing business.

All of us at Health Benefits Associates are concerned, of course, and are always ready to help you with any questions from our Medicare Advisors. Our top priority is to work with the health system for market-competitive rates so that our clients have access to affordable health care. Don’t hesitate to call!