Providence, Aetna reach agreement; coverage for 35,000 Washingtonians stays in tact

UPDATE, 9/3/24: Providence and Aetna announced Tuesday they reached an agreement that will no loner affect Washingtonians with Aetna insurance.

The health insurer and hospital system agreed to a multi-year contract, allowing current Aetna clients to stay in-network at Providence hospitals. Terms of the deal were not disclosed.

“We are pleased to have reached an agreement that puts our patients and members first and look forward to continuing to collaborate to support their care,” a joint statement from the two companies reads.

ORIGINAL STORY:

About 35,000 Washingtonians with Aetna insurance could lose in-network coverage at Providence and Swedish clinics if the two companies do not reach a contract deal by Sunday, the health network said.

In a press release sent Thursday, Providence Swedish said its current contract with Aetna was negotiated in “pre-inflationary times” and hasn’t kept up with costs tied to inflation, such as medications, labor and “supplies.” That’s led to the company taking a $123 million dollar hit in Q2 alone, it said, comparing the loss to CVS Health/Aetna’s $3.7 billion income in the same fiscal quarter.

“Providence is committed to combatting rising costs, yet we cannot do it all on our own,” said Providence CFO Greg Hoffman in the release. “Our partners also need to be part of the solution. For-profit insurers, like Aetna, continue to reap the benefits of multi-year contracts that do not reflect the current health care landscape, with reimbursement increases substantially lower than the costs to provide care.”

Alex Kepnes, the executive director of Communications for CVS Health/Aetna responded to the claims in an email to KIRO Newsradio, describing Providence’s requests as “unreasonable rate increases.”

“We are far apart on terms because Providence is demanding unreasonable rate increases that would raise health plan costs for local employers and out-of-pocket costs for members,” the emailed statement read in part.

More Providence coverage: Patients’ lawsuit claims negligence over potential exposure to hepatitis B and C, HIV

“Providence continues to cite inflationary pressures, but they are proposing to solve them by driving up healthcare costs for local employers that already pay the highest rates,” Kepnes added.

Providence said it has already begun notifying patients of the possible loss of coverage, and Aetna told KIRO Newsradio it sent letters to cardholders in July, but some patients said they are still blindsided.

Esthur, a 91-year-old Swedish clinic patient with Aetna coverage, said she first learned about it from a reporter on Thursday.

“Luckily, I was taking a walk to pay my bill at Swedish, so I’m going to find out more in five minutes,” she told KIRO Newsradio’s Sam Campbell. “I will go right home, get my Aetna card and start calling – and keep calling until I get some information and then do whatever it is I have to do.”

From 2023: Nurses reach tentative deal with Providence Medical Center-Everett

Joe Murlino, another patient at a Seattle Swedish clinic, said he’s gone through a similar scramble before, and he believes the most affected people would be elderly patients.

The impact would be “massive, massive, massive,” he said. “I mean, not only the doctors and what have you, but it’s the prescription medications and everything that goes along with that.”

She is part of the Medicare Advantage Plan, which Aetna said will end on Dec. 31 if no deal is reached with Providence.

Aetna members on its Whole Health – Puget Sound plan can keep their in-network coverage until the end of their current health plan term, the insurer told KIRO Newsradio.

If the health network and insurance company do not strike a deal by Sept. 1, every other Aetna member — which Providence estimates is about 35,000 of its Washington state patients — will have to make contingency plans to keep in-network coverage.

Editors’ note: This story originally was published on Thursday, Aug. 29, 2024. It has been updated and republished multiple times since then.

Contributing: Steve Coogan, MyNorthwest

Sam Campbell is a reporter, editor and anchor at KIRO Newsradio. You can read more of Sam’s stories here. Follow Sam on X, or email him here.

Follow @https://twitter.com/HeySamCampbell