LVHN to end relationship with insurance giant Aetna, tens of thousands expected to be impacted
Lehigh Valley Health Network will stop accepting Aetna insurance next year, a move that could lead to higher out-of-pocket costs for thousands of patients suddenly out of network with their doctors, according to a source familiar with the announcement.
The health network sent a letter Thursday to area employers informing them of the decision to no longer accept Aetna plans as of March 13. A copy of the letter was obtained by The Morning Call.
In the letter LVHN accused the health insurance giant of refusing to pay for health care provided to Aetna members as well as routinely denying or delaying care for patients over the last five years. The letter goes on to say that the network has tried to resolve these issues to no avail since 2017.
As a result, all plans from Aetna and its subsidiaries, including Medicare and Medicaid plans, will not be accepted as in-network at nearly all LVHN-operated facilities when their current contract ends in 120 days. The network has contracted with Aetna for about 20 years.
LVHN officials declined to comment on the announcement. Aetna could not immediately be reached for comment Thursday.
Aetna, which is owned by CVS Health, covers about 39 million people in the U.S., and the move will likely impact tens of thousands of people in the Lehigh Valley who have Aetna insurance and see LVHN doctors. The move will not affect coverage for emergency care or the kinds of care that would be dramatically affected by loss of continuity, like cancer treatment or pregnancy care and childbirth care, according to the letter.
The move by LVHN, which comes more than a week into the federal open enrollment period and during a time when many companies are enrolling employees in new health insurance plans for next year, is sure to be an unwelcome surprise for many people.
Though switching doctors is an option, for those who want to keep their doctor the only real options are to switch insurers, pay higher out-of-network costs, pay out of pocket or wait things out until March in the hopes that the health network and the insurer will be able to work out some kind of deal.
In the letter, LVHN encouraged businesses and employees to contact their Aetna representatives and ask the insurance company to find a solution with LVHN.
This isn’t the first time LVHN has threatened to cut Aetna off during a dispute. In 2000, when the network was still going by the name Lehigh Valley Hospital, it announced it planned to end its relationship with Aetna because of stalled contract negotiations on care reimbursements.
LVH delivered on its promise in March 2001, when a mutual agreement couldn’t be reached. At the time, the health network said thousands of patients switched insurers to stay with their doctors. In 2003, LVH-Muhlenberg, which didn’t follow the other network hospitals earlier, announced it too would end its contract with Aetna.
A new contract was reached in 2007.
LVHN also isn’t the only health care provider to cut ties with an insurance company. Over the last 20 years, numerous other hospitals and health networks have used the same tactic in negotiations with Aetna and other insurers.
Morning Call reporter Leif Greiss can be reached at 610-679-4028 or lgreiss@mcall.com.
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