Philadelphia-based Jefferson Health filed a lawsuit against Aetna over its “level of severity inpatient payment policy” for Medicare Advantage beneficiaries, according to an April 6 filing in a Pennsylvania federal court.
The policy took effect in 2026 after Aetna bumped the start date from November 2025. The policy established a two-tier rate system for inpatient stays based on criteria set by Aetna, the complaint said. This only applies to urgent or emergent hospital admissions between one and fewer than five midnights.
Jefferson Health alleged Aetna’s policy violates CMS’ two-midnight rule, which requires Medicare to cover hospital stays if a physician anticipates a patient needing care for at least two midnights. Since MA plans cannot be more restrictive in coverage than original Medicare, MA plans must also follow this rule.
“Aetna’s ‘policy’ has resulted in administrative burden, financial strain and confusion at the hospitals, resulting in time spent in dealing with Aetna’s ‘policy’ instead of providing patient care,” the complaint said.
The health system is seeking a declaratory judgment, an injunction, attorneys’ fees and costs, and any other forms of relief the court deems appropriate.
“Aetna’s policies, including the level of severity inpatient payment policy, comply with all applicable federal law and regulations and with the terms of our provider contracts,” an Aetna spokesperson said in a statement shared with Becker’s April 7. “Aetna disagrees with the allegations in the lawsuit and will respond in the appropriate forum.”
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