Not Again! Another Stalled Contract Between Provider and Hospital

*This contract dispute has been resolved and as of 03/21/2022, Carson Tahoe Medical Group will be in-network with Aetna Medicare products*

 

Remember when life was so simple? I’ve spent most of my life in Nevada, yet I’m struggling to recall past standoffs between hospital and health coverage. Things have changed, it seems. Now comes news of another contract standoff.

 

Today Seems to be the Age of Uncertainty

Lately, it’s not unusual for providers and insurance companies to negotiate and re-negotiate their contracts.

Earlier this year, Anthem and Northern Nevada Medical Center came to loggerheads. Thankfully that conflict has been resolved.

 

Another New Contract is Stalled

Now we’re watching a rift between Aetna Medicare and the Carson Tahoe Regional Medical Group, a not-for-profit locally-owned healthcare system.

*Carson Tahoe Medical Group and Aetna Medicare Plans are currently in discussions to determine if the medical group will continue to be in-network with Aetna.

 

In Carson City, they run the Carson Tahoe Medical Center. They own two urgent cares, an emergent care center, and some Walmart clinics.

The group offers medical services in Minden, Gardnerville, Dayton, Tahoe, and Yerington.

Aetna’s district director of Medicare sales Carolyn Fregoso tells us, “We are in communications and active negotiations with a renewal date of 5/1/2022. Although we anticipate a successful renewal, the 2022 contract has not been fully executed.”

 

This Comes at a Rather Critical Time

The current open enrollment period (OEP) runs through March 31st.

As we get close to that day, Aetna says they’ll be sharing updates. If you have an Aetna plan with recent claims, you should have gotten a heads-up already.

The Centers for Medicare & Medicaid Services, the government agency that administers the Medicare program, requires Aetna to let you know of possible termination.

 

What Happens if the Contract Isn’t Renewed?

In that unfortunate scenario, Aetna members could lose the benefits they enjoy at Carson Tahoe Regional Medical Center.

Where can you go in that case? Aetna says their care benefits would still be available at Saint Mary’s Medical Center, Northern Nevada Medical Center, and Reno’s new Sierra Medical Center Hospital set to open in late March.

 

Does an Agreement Look Promising for Now?

Aetna Medicare’s Fregoso says, “Both parties have a willingness to come to a successful outcome resulting in a continued partnership with Carson Tahoe Regional Medical Group.” She says you should be “confident this will be positively resolved.”

In the meantime, Aetna is also asking its members to be patient. They promise to keep us here at Health Benefits Associates informed.

 

Stay Up to Date

This is one of several important issues facing medical care in northern Nevada. Are you considering a new or different Medicare plan? As always, you can depend on Health Benefits Associates.

Our offices can be found in Reno, Sparks, Carson City…and soon to open in Fernley.  And follow our website to be consistently informed, at healthbenefits.ocglabs.com.