Beginning Jan. 1, ProMedica physicians will be considered out-of-network for commercial Aetna members, who will be billed 100 percent for any services received. Aetna’s Medicare Advantage members will maintain in-network access to the physicians until June 1. Impending network changes could disrupt care the group’s 950 salaried physicians provide to some 27,000 Aetna members.
Rates are a cornerstone of the physicians’ stronghold, as the group said it hasn’t received a rate increase from Aetna in six years. James North, MD, a salaried family practitioner with ProMedica Physicians Group, told The Blade Aetna pays the lowest rates compared to other local and national commercial payers.
Aetna told The Blade Dec. 8 it is “in active negotiations with ProMedica and hope[s] to reach a new contract that is fair and reasonable for our members and the ProMedica System.”
ProMedica hospital and ancillary care will remain covered by Aetna even if a deal collapses.
More articles on payers:
Humana shakes up leadership team: 4 things to know
Judge calls for another hearing on CVS-Aetna deal: 3 things to know
BCBS exec tells Texas business leaders to ‘stand with your carrier’
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
