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.
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.
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
