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Patients with Aetna could lose coverage at NJ's largest health system in just weeks
By
Caroline Lewis
Published Jun 15, 2024
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By
Caroline Lewis
Published Jun 15, 2024
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New Jerseyans insured by Aetna could soon lose coverage for hospitals, clinics and doctors in the expansive Hackensack Meridian Health network if the two health care behemoths don’t resolve a contract dispute by July 1.
Hackensack Meridian is the Garden State’s largest hospital chain and health network. It operates 18 hospitals in addition to urgent care centers and outpatient clinics, and employs about 7,000 physicians.
If Hackensack Meridian and Aetna allow their contract to end on June 30, some patients will be affected right away while others will maintain coverage for an extended period, depending on what type of health plans they have.
Patients on the Aetna Medicare Advantage plan will lose coverage for Hackensack Meridian immediately on July 1 if the dispute is not resolved. For patients with “self-insured” plans — a type of plan that gives employers more control over benefits — Hackensack Meridian will be out of network starting on Sept. 29. Patients with “fully insured” plans, which include some employer plans and plans purchased on the Affordable Care Act marketplace, will lose coverage a month later on Oct. 29.
Patients insured through their employers may have to ask which type of plan they have.
But patients who are pregnant, recovering from surgeries or undergoing cancer treatment might be able to keep seeing their doctors for longer. Both New Jersey and federal law require health plans to allow patients in the midst of care for certain medical conditions to continue seeing their doctors at the same in-network rates for a period of time after a contract is terminated.
According to Hackensack Meridian, patients will have to apply for extended coverage through Aetna.
Hackensack Meridian sent patients a letter earlier this month warning them that they could lose access to their doctors and hospitals, or have to pay more out of pocket, if the dispute is not resolved. Hackensack Meridian urged patients to call Aetna to give the insurer a piece of their minds. It’s the the latest major health network in the region looking to use pressure from patients in their contract negotiations, following in the footsteps of Mount Sinai Health System and New York-Presbyterian.
Aetna said in a statement that the health network is demanding “unreasonable, double-digit [percentage] increases in the prices of their services.” Meanwhile, Hackensack Meridian has posted on its website that it is struggling to cover the rising costs of inflation, staffing and supplies and pointed out that Aetna reported nearly $6 billion in profits last year.
Still, Hackensack Meridian has advised patients not to jump the gun and switch health care providers just yet. And some patients may also decide to simply pay more to keep their current health care providers.
Tracey Hallman, an Aetna member who lives in Freehold, said all her doctors are in the Hackensack Meridian network, including the endocrinologist she visits to maintain her health following a bout with thyroid cancer.
“I'm just establishing a relationship with him,” Hallman said of her endocrinologist, who she started seeing two years ago. “I feel he has excellent bedside manners. I don't want to change.”
Hallman said if she loses in-network coverage, she will likely pay more out of pocket to continue seeing the same doctor.
“It's a financial burden if you really do want to stay,” she said.
She added that she finds the situation frustrating but is glad Hackensack Meridian has been communicating with her about the possibility of losing her coverage.
Both Hackensack Meridian and Aetna said they are still working to reach a deal before the end of the month.
Other similar disputes have been resolved this year with varying levels of disruption for patients.
In New York, when Aetna feuded with New York-Presbyterian earlier this year, the two entities reached an agreement days before their contract was set to expire.
Mount Sinai Health System and UnitedHealthcare, on the other hand, ended their contract at the end of last year over a billing dispute, allowing patient care to be disrupted — but reconciled by March.
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new jersey
Health and Science
Caroline Lewis
Caroline Lewis is on the health care beat for WNYC and Gothamist. She has covered COVID, a nurses' strike, the overdose crisis and New York’s marijuana legalization effort, and spent a year investigating patients' medical bills. She always wants to hear about how everyday New Yorkers experience the health system. Got a tip? Email [email protected].
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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