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Coventry medical insurance customers roiled in Piedmont contract tussle

Coventry healthcare insurance policyholders in Fayette and Coweta counties got a troubling letter in the last few days — notice that the main hospital and physicians group in this area would no longer be “in-network” for them.

If Piedmont Healthcare and Piedmont Physicians Group would no longer be available to thousands of Coventry policyholders as in-network providers, costs could skyrocket for the patients.

The uncertainty results from last-minute contract negotiations, something the Georgia Department of Insurance has no jurisdiction over, according to spokesman Glenn Allen.

The two sides have sent out letters to customers warning that Jan. 31 is the deadline for the deal either to be signed or rejected. It costs significantly more for a policyholder to receive care from a provider who is “out of network.”

Piedmont Healthcare Public Relations Senior Director Diana Lewis in a Jan. 13 statement said the current contract between Piedmont Healthcare and Aetna/Coventry expires on Jan. 31.

The contract includes all five hospitals – Piedmont Atlanta Hospital, Piedmont Fayette Hospital, Piedmont Henry Hospital, Piedmont Mountainside Hospital and Piedmont Newnan Hospital — and approximately 1,000 physicians who make up the Piedmont Physicians Group, Piedmont Heart Institute Physicians and Piedmont Clinic, Lewis said.

“It is important Piedmont patients and the community know the facts if the contract expires Jan. 31. Aetna/Coventry, which became a combined company in May 2013, will, in all likelihood, begin forcing the choice of a new doctor for HMO members. HMO and PPO/POS patients may incur higher out-of-pocket costs for care received at Piedmont hospitals and from Piedmont physicians as out-of-network providers beginning Feb. 1, 2014,” said Lewis.

Lewis said Piedmont mailed letters on Jan. 13 to patients who are insured with Aetna/Coventry and have visited a Piedmont physician, clinic or hospital in the last 18 months explaining that negotiations are continuing. “We remain hopeful that we will have an agreement on a new contract effective Feb. 1, 2014,” Lewis said.

Lewis noted that negotiations between healthcare providers and insurance companies is not uncommon.

“Hospitals and healthcare systems renegotiate contracts with health insurance companies all the time, and it is not unusual for an agreement to be reached at the last minute. We are working diligently to renegotiate this contract on behalf of our five hospitals and physicians without creating undue anxiety or worry for our patients, Lewis said.

“Piedmont is committed to continuing negotiations in good faith to reach a resolution that ensures access to the best hospitals and physicians in the community for our patients enrolled with Aetna/Coventry, choice for consumers, quality care, and a fair and equitable contract.”

Lewis said Piedmont will keep patients updated with the latest news at piedmont.org.

Aetna/Coventry may be reached with benefits questions at 770-346-4300.

Aetna/Coventry public relations spokesman for the Southeast U.S. Walt Cherniak on Tuesday said the company is involved in negotiations with Piedmont and he is very hopeful of a resolution before Jan. 31.

“It is not our desire for them to leave our network,” Cherniak said. “We’re very hopeful (that we will) reach a resolution and get a new contract.”

Aetna purchased Coventry in 2013. Cherniak noted that both Aetna and Coventry have contracts in Georgia, adding that notification requirements mandate that both doctors and patients be informed when the potential exists that the contract between an insurance company and a healthcare provider might be affected.

Though the numbers specific to policy holders in Fayette and Coweta counties were not available, Cherniak said Aetna/Coventry covers more than 600,000 Georgians and has contracts with all or nearly all the hospitals in metro Atlanta.

Piedmont's statement in full is as follows:

REGARDING AETNA/COVENTRY PROVIDER NETWORK CONTRACT

The current contract between Piedmont Healthcare and Aetna/Coventry expires on Jan. 31, 2014.

The contract includes all five hospitals: Piedmont Atlanta Hospital, Piedmont Fayette Hospital, Piedmont Henry Hospital, Piedmont Mountainside Hospital and Piedmont Newnan Hospital — and approximately 1,000 physicians who make up the Piedmont Physicians Group, Piedmont Heart Institute Physicians and Piedmont Clinic.

Piedmont mailed letters on Jan. 13 to patients who are insured with Aetna/Coventry and have visited a Piedmont physician, clinic or hospital in the last 18 months explaining that negotiations are continuing. We remain hopeful that we will have an agreement on a new contract effective Feb. 1, 2014.

Hospitals and healthcare systems renegotiate contracts with health insurance companies all the time, and it is not unusual for an agreement to be reached at the last minute. We are working diligently to renegotiate this contract on behalf of our five hospitals and physicians without creating undue anxiety or worry for our patients.

However, it is important Piedmont patients and the community know the facts if the contract expires Jan. 31.

Aetna/Coventry, which became a combined company in May 2013, will, in all likelihood, begin forcing the choice of a new doctor for HMO members. HMO and PPO/POS patients may incur higher out-of-pocket costs for care received at Piedmont hospitals and from Piedmont physicians as out-of-network providers beginning Feb. 1, 2014.

Piedmont is committed to continuing negotiations in good faith to reach a resolution that ensures access to the best hospitals and physicians in the community for our patients enrolled with Aetna/Coventry, choice for consumers, quality care, and a fair and equitable contract.

Piedmont will continue to keep patients updated with the latest news at piedmont.org.

Comments

These issues usually get resolved at the last minute. Too much money on the table for both. And many unhappy clients.

I'm in Coventry and got three letters yesterday. Scared the wife. If they don't settle, maybe I can find a new allergist that doesn't make me pay $15 out of pocket twice a week ($120/mo) to give my kid a shot that takes 5 min.

That "5 minute shot" is administered by someone who invested time and money getting a degree, certification and license. They pay rent and utilities, insurance, employee payroll and associated benefits and taxes. They purchase the medications from pharmaceutical companies that exact top dollar for their products. They pay for disposal of haz mat materials, including the syringe used to inject your child. Room sterilization is the same for a "5 minute" visit as an hour marathon. Appointing, checking in and dismissal are not streamlined for quickie visits. Continuing education classes mean time away from the practice.
Insurance is a benefit, NOT an entitlement and not designed to cover all of our medical expenses. (Similar to Social Security which is NOT designed to pay all our retirement expenses) . If your insurance is provided by your employer, they are the ones you should complain to. Employers have every choice available in providing coverage and your out of pocket expenses, co-pays and policy limitations are selected by the "Corporate" office, NOT the insurance company.
For the record, I am not affiliated with either the medical or insurance industries.

Same damn thing happened couple of yrs ago with Piedmont & Aetna---before Aetna bought Coventry in 2013! Coincidence? Maybe, maybe not but it sure is a disservice to patients/clients in Georgia.

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