NewYork-Presbyterian, Aetna dispute may leave Hudson Valley patients scrambling for coverage

NewYork-Presbyterian hospitals and health providers across the Hudson Valley may soon be considered out-of-network for patients with the Aetna health plan.

The change would take effect April 1, unless a new health insurance coverage deal is reached by March 31. The potentially impacted hospitals include NewYork-Presbyterian Westchester in Bronxville (formerly Lawrence Hospital), and Hudson Valley Hospital in Cortlandt, as well as related medical groups and the behavioral health center in White Plains, according to letters the health system is sending patients about the ongoing contract negotiations.

The potential move to out-of-network — which would increase what Aetna customers pay for health care at more than 19 NewYork-Presbyterian sites across the New York City metro region, or force them to seek alternative in-network providers — is the latest example of New Yorkers being harmed when contract negotiations break down between health providers and health insurers.

Earlier this year, WellNow Urgent Care sites across upstate New York dropped in-network Excellus BlueCross BlueShield coverage.

Prior health contract clashes in the Hudson Valley over the past decade featured similar disputes over coverage and reimbursement rates between a variety of health plans and hospital networks. The stakes have mounted as the cost to provide medical care in New York keeps rising and the national health worker shortage fuels ever-expanding crises inside the state's health system.

Why NewYork-Presbyterian, Aetna contract talks stalled?

NewYork-Presbyterian and Aetna contract talks were focused on how much Aetna pays the health systems' hospitals and medical practices for care provided to Aetna members. The contract being negotiated is for several Aetna lines of business including employer-sponsored and professional employment organizations, as well as Medicare Advantage health plans, the health system noted on its website.

The health system asserted it initiated talks with Aetna well before the contract end date of March 31. "So far, Aetna has presented an unreasonable offer," the system said in a statement posted online for patients without providing further details.

Contract disputes: WellNow Urgent Cares drop in-network Excellus coverage in NY. What you should know

NewYork-Presbyterian added it remained "hopeful that Aetna will continue to engage in good faith negotiations to reach a reasonable offer that puts patients first."

In a statement to USA TODAY Network Monday, Aetna asserted it was currently "far apart on terms" with NewYork-Presbyterian because the health system "is demanding significant increases in reimbursement rates that are unsustainable and will materially raise costs" for Aetna's health plan sponsors and members.

Aetna remained "committed to negotiating in good faith for a fair contract," the statement added.

It was unclear exactly how many Aetna customers currently use NewYork-Presbyterian services, with the insurer covering more than 1.8 million patients overall in the New York City metro area, city records show.

The health plan's commercial market share ranks third largest nationally, covering tens of millions of patients across the country, according to the American Medical Association.

Aetna out-of-network: How big of a price increase?

If contract negotiations fail, Aetna customers who wanted to stay with their NewYork-Presbyterian health providers could be faced with out-of-network costs that increase their medical spending by thousands of dollars, according to Aetna's website.

For example, an Aetna member requiring a five-day hospital stay might owe $1,750 out of pocket if they use an in-network provider. That hypothetical cost jumps to $19,750 for an out-of-network hospital, the health insurer noted in a customer information document.

For an outpatient surgery procedure, that estimated patient cost gap increased from $120 for Aetna network providers to $1,040 for out-of-network, records show.

ColumbiaDoctors and Weill Cornell Medicine providers will not be immediately impacted by the April 1 contract expiration regardless of their office location, the health system noted. Their care will be delivered in-network to Aetna customers through May 31, regardless of the outcome of contract negotiations.

This article originally appeared on Rockland/Westchester Journal News: NewYork-Presbyterian, Aetna dispute: Will Hudson Valley lose coverage?