PriMed told its Aetna patients either to find new physicians or, if they want to keep seeing a PriMed doctor, pay higher out-of-network charges for medical care. The shift could mean a major disruption for patients with chronic conditions that require regular maintenance.
PriMed and Aetna officials both said they are working with patients to help ease the transition. The two sides could not come to an agreement on reimbursements for services.
In the most recent round of negotiations, “Aetna offered the lowest reimbursement of all the carriers we deal with,” said Jim Moffett, PriMed’s executive director.
In the letter to patients, Moffett wrote that PriMed was “surprised by Aetna’s position” in contract negotiations.
In an interview, Moffett said PriMed focuses on quality care aimed at managing chronic conditions, such as diabetes and high blood pressure, with an aim to reduce expensive complications, such as heart attacks and strokes.
“We just reached a point where what Aetna was paying wasn’t supporting our quality of care,” he said.
He would not disclose the amount, or indicate how much Aetna’s offer was below other insurers.
In a notice to its Aetna patients, PriMed said it “participates with every other carrier in Greater Dayton. This is the first and only time that we have not been able to reach an agreement with a health insurance company.”
An Aetna spokesman said the two parties have been in negotiations since January, and that PriMed notified them in April they were terminating the contract.
“PriMed is seeking double-digit increases that are unaffordable in today’s economy,” Aetna spokesman Scot Roskelleywrote in an e-mail reply. “If we were to accept their increase request, it would put them way above the market average.
“They say we pay less than other insurance companies. Our analysis indicates otherwise — that we are competitive with other payers. It is our responsibility to negotiate fair contracts for Aetna members. The prices we negotiate impact our members’ out-of-pocket costs as well as premiums paid by them and their employers. Our offer reflects local market rates as well as the consumer price index rate for physician services.”
It is not uncommon for insurers and health care providers to announce they could not reach contract agreements, only later to agree to contract renewals. In March 2011, Aetna announced it could not reach a contract with UC Health, the largest specialty practice group of physicians and hospitals in the Cincinnati area, including West Chester. In August this year, the two sides announced they were under contract for coverage through July 31, 2015, that covers 165,000 patients.
And that could still happen with Aetna and PriMed, both sides said.
PriMed employs about 55 physicians and operates primary care and specialty physician offices in Beavercreek, Dayton, Miamisburg, Centerville, Kettering, Huber Heights, Springboro and Vandalia.
Aetna has about 46,000 members in the Dayton region.
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