WellStar Health System has sent 14,000 letters to patients saying it may terminate its relationship with Aetna insurance company.
While the letters have alarmed patients who worry they'll have to switch hospitals or insurance companies, an Atlanta health consultant said the letters could simply be a negotiating tactic and that people probably have little to worry about.
Michael Rovinsky of Integrity Consulting Group said such letters have become a commonplace tactic during hardball negotiations between insurers and hospitals, used by both sides. One side, for instance, might use the letter to alarm patients, who then could call and apply pressure to the other side to settle the negotiations, he said.
"It's using patients as a pawn for negotiations," said Rovinsky, a healthcare consultant for some 25 years.
The great majority of these negotiations work out, he said.
WellStar senior vice president of managed care Barbara Corey told The Atlanta Journal-Constitution in an email that the letter was intended "to ensure continuity of care and provide information needed to patients to make upcoming benefit decisions, if applicable."
About 38,000 metro Atlanta households have at least one family member who used a WellStar facility or doctor in the past year, according to Aetna officials. WellStar officials said they notified patients of health system physicians, not those who had been hospitalized.
Should WellStar cut ties with Aetna, it could cause problems for people who use the health system's five hospitals or ancillary facilities in Cobb, Cherokee, Douglas, Paulding and Bartow counties. If they stayed with the hospital, they would face greater out-of-pocket costs since the hospital would then be considered outside the Aetna network.
Switching insurance companies also raises challenges, in that some patients are insured through employers who only allow such changes once a year.
The WellStar letter, which some families received as recently as Thursday, says that the health system has been unable to reach a new contract agreement with Aetna and that the existing contract terminates on Aug. 31.
The letter includes a listing of managed care and insurance companies with which WellStar has contractual relationships.
"You may find this information useful if you are making new coverage decisions with your employer over the next few months," said the letter signed by Corey.
Both sides say they are continuing to negotiate and hope to resolve the conflict.
Aetna spokesman Walt Cherniak said the sticking points in negotiations center on the rates that the insurance company pays for various services.
"WellStar has asked us for increases that we believe are excessively high," he said.
Corey, of WellStar, said Aetna is paying other Atlanta hospitals and physician groups more than it is paying WellStar.
"We are seeking comparable market rates," she said.
It is not unusual that Aetna reaches agreements after such letters are sent out to patients, Cherniak said. The WellStar letter went out about 10 weeks prior to the termination date.
Aetna sends out its letters about four weeks before the contract expires, he said. He said those letters are strictly for notification purposes.
Some of these contract fights between insurers and hospitals can get rough, even for the patients.
In 2006, the wrangling between Piedmont Healthcare and Blue Cross and Blue Shield included not only letters to patients but dueling newspaper ads and television interviews.
In that case, the contract lapsed, leaving about 130,000 Piedmont patients in limbo for about a month before an agreement was made. During that time, people had to chose whether to leave their doctors and keep their Blue Cross coverage, stay with their doctors and pay more for care, or put off treatment while hoping a new contract agreement would come.
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