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AETNA/CHI FAQ

Why is this happening?

When a series of providers like hospital chain agree to be "in-network" there are financial considerations for both parties. The doctor/hospital gets a certain level of "guaranteed business" for them because a large chunk of population has that particular insurance carrier. In return, there is a bit of a "volume discount" where the provider is accepting large amounts of business at a lower payment. 

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Just like when a TV station agrees to a contractual agreement so they are carried by a cable or satellite provider; this is quite similar. 

Who is at fault with this?

Sorry, I'm not privy to the specifics of this contractual dispute. 

Has this happened before in the Omaha area?

It has, although I don't recall any incidents since 2014. 

Can this happen with other Medicare providers?

Absolutely, it could. 

What happens if I go to a CHI provider with an Aetna plan after 9/30?

You could be responsible for the full amount of care.

What if I have a PPO plan?

Yes, that allows you to go out-of-network providers but the additional higher copay, may still not be something you'd want to pay. 

Does this apply to Medicare supplements?

No, there are no networks. With a true Medicare supplement, a patient/policy holder may visit any provider in all 50 states provided they accept Medicare. 

How does continuation of care work?

If you have "ongoing" care. For example, a surgery that has months of rehab, if the additional care is beyond the 9/30 deadline, you should be able to finish your ongoing care. 

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Specifics: HOW does that occur? Is there a form to fill out? Is there some kind of appeal that is required? Those have yet to be communicated to us. Stay tuned. 

What can I do in the meantime?

I would make certain all of your prescriptions have sufficient number of refills already added so a fall appointment isn't required to refill prescriptions. If you have a late December appointment, you may want to try to reschedule it for early January. If you have one in early October, you may want to see if it can be rescheduled into September. 

When can I change from one insurance company to another?

There is a fall enrollment period from October 15th to December 7th. For certain changes, there can be an additional period from January 1st to March 31st. 

Aetna Update: September 30th, 2024

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Update: September 17th, 2024

We learned a lot today.

First of all, there are a lot of smaller providers in town who utilize CHI as their physicians hospital organization. In other words, these providers affiliate themselves with CHI to assist in billing are, etc. 

There has been a wave of these smaller providers upset with the way negotiations are going and absolutely want to remain in the Aetna network. They are leaving their CHI affiliation in droves and either contracting with Aetna directly or through a different PHO.

Here is a partial list of these providers:
- Center of Dermatology, PC
- Omaha Nephrology, PC
- Omaha/Lincoln Eye & Laster Institute, INC
- Advanced Medical Imaging Surgery Center
- Boys Town National Research Hospital
- Boys Town Internal Medicine Clinics
- Boys Town Ear, Nose and Throat Clinics
- Midwest Eye Care PC
- Eye Consultants PC
- Nebraska Hematology – Oncology PC
- Papillion Family Medicine
- ENT Physicians Kearney
- Family Practice Associates
- Family Practice of Grand Island

All are already committed to remaining in the Aetna network beyond 10/1/2024.

This puts pressure on CHI to settle this dispute because each one of these providers leaving their CHI PHO affiliation represents lost revenue for CHI.  These providers want no part of this dispute.

Aetna has told us they remain optimistic they will be able to come to an agreement.  They made another offer to CHI on 9/9/2024 and have yet to hear a response.  Another frustration is the team they are dealing with at CHI is a completely different set of people than they originally started negotiating with which has cost time in this process.

For those who have ongoing treatments and wish to apply for a "transition of care" waiver, I do have these forms now.  It is not a guarantee the request will be honored, but for those who wish to apply, I can forward the form.

More updates on this website (nationalseniorinsurance.com) as they become available.  Thank you for your trust and confidence in us in helping navigate a difficult situation.
 

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