Con?ict leaves patients in lurch

A dispute concerning rising health care costs might lead to the termination of a contract between UNC Hospitals and an insurance provider early next month, leaving thousands of patients in the lurch.

UNC has raised the costs of service far beyond what Aetna’s patients might be able to pay, said Walt Cherniak, spokesman for the Connecticut-based insurance agency.

Unless the two parties come to an agreement by Feb. 5, UNC Hospitals will become an out-of-network provider for patients insured by Aetna. This means patients insured by Aetna will be paying much higher fees for service at UNC.

“Although we’ve reached out as recently as yesterday, we have no negotiation sessions scheduled,” Cherniak said.

“We have offered a fair increase,” he said. “But we certainly can’t pay what they’re demanding.”

UNC’s increases would translate into direct fee increases for Aetna’s customers, Cherniak said.

“And they have a profitable contract with us now,” Cherniak said.

“What happens when a hospital raises its rates is the rates get passed on to customers,” he said. “No one in this economy needs to be taking on this kind of increased cost.”

For example, a deductible at a UNC doctor’s office that would previously cost the patient $100 would cost $152 with UNC’s proposal, he said.

But UNC Hospitals spokeswoman Jennifer James said Aetna is not paying UNC at market rate.

“They are paying other providers in the Triangle significantly more,” she said. “We’ve made a lot of concessions, but they’re not willing to pay us what we think is reasonable and what they’re paying other providers.”

“It’s not fair they’re doing this to us,” James said. “We don’t think they’ve been willing to work with us.”

UNC gave Aetna notice of contract termination in 180 days last summer, then extended it until February, Cherniak said.

They followed up with a contract proposal with unreasonable cost increases in the double digit percentages, he said.

James said UNC Hospitals is encouraging patients covered by Aetna to talk to the agency about continuation of care.

“We do have procedures in place for people who have already started a treatment at UNC and Rex,” Cherniak said. Rex Healthcare is a hospital in the UNC Health Care system.

A woman who has had her prenatal appointments at UNC will be able to have her baby there, he said.

James said UNC will treat patients who have already started care at their facilities on a case-by-case basis.

“We obviously want less people affected by this,” James said.

In the last year, Aetna has paid out 8,400 claims for clients treated at UNC and Rex, Cherniak said.

But the number of patients actually treated there is probably a lot smaller, because each individual patient likely filed more than one claim, he said.

Aetna has about 300,000 patients statewide, Cherniak said. The two main in-network providers are Duke Hospitals and WakeMed Health and Hospitals.

At this point, Aetna is proceeding with the assumption the termination will be final in February, Cherniak said. They are sending notices of termination to businesses, physicians and other customers.

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