Home Column Westchester County Association calls on Aetna to keep Montefiore coverage

Westchester County Association calls on Aetna to keep Montefiore coverage

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Montefiore Health System could be forced out of Aetna’s provider network on Sept. 8. That means this list of hospitals — White Plains Hospital, Montefiore Medical Center,

Montefiore Mount Vernon, Montefiore New Rochelle, Montefiore Nyack, and St. Luke’s Cornwall Hospital — and more than 3,500 physicians will no longer be available to people living in this region as a covered in-network benefit. Employers who selected Aetna for their employees will be faced with finding new health insurance to keep employees and their families protected from out-of-network bills and challenging access issues. This will prove extremely challenging for so many people in our community.

Health insurance has become such a burden for many businesses, organizations and individuals. It is one of the largest expenses for many companies and an increasing burden on employees. Over the years, benefits have become more complex, and no one can ever be sure that their insurance company will really step up and meet its obligations.

This move by Aetna to freeze out Montefiore Health System may be just a list on some provider directory at Aetna’s headquarters in Hartford, Connecticut, but here in our community, it’s the difference between good insurance and worthless insurance for many people.

In case anyone wonders whether insurers such as Aetna are playing hardball due to financial necessity, bear in mind that since January 2014, health insurance stocks outperformed the S&P 500 by 106 percent. Couple that with the increase in denials across the nation, it’s clear that their business model is about managing economics, not health care.

Hospitals in our region are all not-for-profit and their mission focuses on the health of the community. In fact, Montefiore has implemented many initiatives with the Aetna population to keep members healthy and, as part of that, are saving employers and Aetna money by reducing the cost of health care.

It’s critical for any community pursuing economic development and job growth to provide access to high-quality health care. In our region, the health-care sector is by far the largest economic driver, generating economic activity of almost $18 billion and employing more than 50,000 people. Many regions of the country are envious of the hospitals and physicians we can access in our corner of the world, and Aetna’s aggressive push to slash payments to local health-care providers does nothing to support our health-care system. We want hospitals investing in new technologies and novel treatments, expanding access to meet the needs of the community. We want physicians to stay here and build their practices. Aetna’s payments to providers provide an important piece of that puzzle, and the part they play in making it all work.

Employers really want health care to work, whether they’re already based here or considering relocation or expansion in the area.

It’s obvious from this week’s media coverage that Montefiore Health System leadership is very concerned that Sept. 8 will pass without a new contract in place and their facilities will be out of network. It’s equally clear from public statements that Aetna leadership doesn’t want anyone to look at other insurance options, and they’re trying to calm the market.

Our sole concern is that Montefiore Health System physicians and hospitals remain as an in-network option for the community, and Aetna use the premiums it collects to support local nonprofit organizations. We can all agree that is best for our community, whether or not you have Aetna insurance.

A thriving local economy counts on many factors, from education to workforce development to health care. We can all hope that Aetna will change course and keep Montefiore Health System hospitals and physicians as in-network providers. We all want our health insurance to mean something, to protect us from financial harm and give us the choices we need.

 

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3 COMMENTS

  1. Health Insurance is the biggest scam in the world..it is time to bring charges against AETNA and other companies like it. There stock is at an all time high and the profit margins keep increasing…

  2. It is a business negotiation. The fact that Monte is ASKING insureds who pay money for their insurance to go back and say, “yes Aetna, please pay Montefiore, one of the highest paid hospitals in the State, 60% above what is reasonable and customary by Medicare standards” is preposterous. Think about it this way, If Montefiore gets the 60% increase, where do you think companies like Aetna and UHC are going to get it? That’s right, the insureds who went to bat for the hospital will be seeing this. There is no such thing as a non-profit hospital, insurance company, or anything else for that matter. Everything in this world is for profit of some kind. Both kids need to work on playing better in the sandbox.

  3. Also, Aetna offers PPO plans with Nationwide networks which is why people enroll in them. So their co-pays will be a bit higher at this one Hospital network. For the average user of their play, co pays aren’t the issue. They can still seek treatment at Monte and Aetna will pay as an “out of network” benefit. They do not LOSE their doctors. And articles like this just feed the fear that people have and breed negativity. Their premiums will remain in tact and Monte will be getting paid LESS than what they were when they were contracted without receiving bonuses for keeping members out of the Hospital. So in the end, Monte is LOSING out by not resigning.

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