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Insurance company notices

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I have now received several notices letting us know that nearly all of our GP and specialists are no longer covered under Aetna....HUH?> Anyone have some insight as to what is going on. We have been having problems with insurance not paying on our bills after we have paid all of our co-pays :blink: . I am wondering should I contact Wellstar or insurance company as to who in the Tanner health system we need to use...they have even gone so far as to say Paulding hospital is now out of network. Go figure. We have some very important medical issues with hubby and now the surgeon and his GP are both not covered...... :wacko:

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Somebody else has a thread on this. I called several doctors yesterday and talked to their benefits coordinators to get their general feeling on how well the contract negotiations are going between AETNA providers and AETNA. The opinions I received were that they all felt pretty confident an agreement would be reached soon. I wouldn't worry too much about it. Hopefully it will work out in a timely manner. :)

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I have now received several notices letting us know that nearly all of our GP and specialists are no longer covered under Aetna....HUH?> Anyone have some insight as to what is going on. We have been having problems with insurance not paying on our bills after we have paid all of our co-pays :blink: . I am wondering should I contact Wellstar or insurance company as to who in the Tanner health system we need to use...they have even gone so far as to say Paulding hospital is now out of network. Go figure. We have some very important medical issues with hubby and now the surgeon and his GP are both not covered...... :wacko:

 

I am currently doing some research into this, things are going to get worse before they get better.

What I am seeing is that the healthcare reform bill has now given private insurance companies the upper hand when it comes to doctors and hospitals.

We all want to believe that insurance companies are going to be our friend, they are going to drive the cost of healthcare down.

This is untrue, the power they have gained allows them to lobby for our premiums, deductibles and co-pays. They will use this to to drive up their profits and drive the quality of care down.

You are going to see a big lobbyist push against the federal medicare package, they are going to tell us if we want to fight single payer and keep the government out of healthcare we will have to pay for it.

They will strangle our hospitals and cutting edge treatment all in the name of keeping cost down and fighting socialized medicine.

We need to wise up and fight for our healthcare professionals and modern hospitals before it is too late.

The debate will be framed as bad hospitals and doctors against good insurance companies.

I am going to book mark this thread and show people what is happening a year from now.

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I have now received several notices letting us know that nearly all of our GP and specialists are no longer covered under Aetna....HUH?> Anyone have some insight as to what is going on. We have been having problems with insurance not paying on our bills after we have paid all of our co-pays :blink: . I am wondering should I contact Wellstar or insurance company as to who in the Tanner health system we need to use...they have even gone so far as to say Paulding hospital is now out of network. Go figure. We have some very important medical issues with hubby and now the surgeon and his GP are both not covered...... :wacko:

 

That does not sound good, especially since paulding is getting a new hospital..

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This is what happens when insurance companies finance the campaigns of politicians who in turn write the bills.

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After I asked a similar question I was reminded that this very thing happend several years ago only it was Wellstar and Cigna. At that time we had Cigna through Lockheed and we were not happy to have to change from the wellstar group. At that last minute of negotiations they came to a settlement. So I have decided not to change one thing until it is a done deal.

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Thank you all for the feedback, I was just surprised because they sent about 10 different notices listing different doctors individually. It seemed kind of excessive. It probably is a consumer scare tactic to make us raise the roof with whichever company we can. Good to know I hopefully have no worries :yahoo:

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We've received about 4 of the aetna notices for my sons pediatrician office. I called aetna and they told me it showed that 300+ wellstar doctors are no longer going to be covered by aetna beginning Sept.1. Hopefully there will be an agreement reached. You'd think with the money we have to pay in monthly they would do what they could to keep us as customers! We will probably be switching to another insurance co. if they do not come to agreement. ALL thats around us is Wellstar. Who wants to not be able to go to their nearest hospital and drive many miles from home just for a sprained ankle or something thats kinda an emercency at the time but not life threatning. I would hate to know I couldnt go to my nearest hospital and be covered!:angry2:

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This is what happens when insurance companies finance the campaigns of politicians who in turn write the bills.

 

 

Dang !! Where's the link???

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The practice of an insurance company sending a letter to patients, informing them that their physicians may not longer be accepting their insurance, has become a common PR pressure tactic the last few years. Several years ago the same thing happened between Aetna and Wellstar to employees of a large insurance company (ironic) with offices in Atlanta. The goal is to have enough patients call Wellstar and complain, to force Wellstar to reconsider their position. Most of the time it works.

 

This is similar to what cable companies do. They run streamers at the bottom of the screen, stating that due to contractual issues, a certain channel may no longer be carried. Customers are supposed to call their cable operator and tell them to do whatever it takes to keep the channel. It's a sad tactic.

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Have they reached an agreement yet? Someone told me they were talking about this on the news but I can't find anything about it.

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Okay - so would you rather your insurance company/doctor NOT tell you that there's a problem? Would you rather just show up at your next appointment and have the lovely lady at the counter tell you that, oh, by the way, we don't take your insurance anymore? Often our appointments are made 3 months out - now THAT would torque me.

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I hate insurance companies.

 

I put them in the very same boat

as big oil companies -and the drug industry.

 

I have a nasty name for that boat.

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From my understanding.... an argeement will probably be made in the eleventh hour on August 31. This has happened in the past with aetna... I am hope an agreement is made. It would suck having to change DRs...

Edited by ksee4

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Here is a notice that Aetna sent out to some of the employers they have contracts with, which sheds a little light on what's going on: Network Update

 

 

July 27, 2012

 

 

WellStar Health System (WellStar Cobb Hospital, WellStar Douglas Hospital, WellStar Kennestone Hospital, WellStar Paulding Hospital, and WellStar Windy Hill Hospital) with locations in Cobb, Douglas, and Paulding Counties, GA may terminate from our Atlanta GA Aetna network effective August 31, 2012

 

 

Highlights

 

 

  • Our contract with WellStar Health System (WellStar Cobb Hospital, WellStar Douglas Hospital, WellStar Kennestone Hospital, WellStar Paulding Hospital, and WellStar Windy Hill Hospital) has a scheduled 8/31/2012 termination date.

  • Aetna and WellStar have been in negotiations for a new contract.
  • WellStar is requesting a significant rate increase for their new contract.
  • We continue to work very closely with WellStar towards reaching an agreement that is in the best financial interest of our members, customers and Aetna prior to the termination date.

  • Negotiating reimbursement rates with health care providers is a key component to controlling costs that is directly connected to our ability to provide affordable health care coverage for our members.
  • All services provided by the WellStar hospitals are available at alternate participating hospitals.
  • Medicare member letters were mailed the week of July 1st in compliance with CMS guidelines.
  • Commercial member letters will be generated and mailed the week of July 30th.

 

Hospital Locations

 

WellStar Cobb Hospital

 

3950 Austell Road

 

Austell, GA 30106

 

 

WellStar Douglas Hospital

 

8954 Hospital Drive

 

Douglasville, GA 30134

 

 

WellStar Kennestone Hospital

 

677 Church Street Northeast

 

Marietta, GA 30060

 

 

WellStar Paulding Hospital

 

600 West Memorial Drive

 

Dallas, GA 30132

 

 

WellStar Windy Hill Hospital

 

2540 Windy Hill Road

 

Marietta, GA 30067

 

There are 379 WellStar employed physicians who may also terminate effective 08/31/2012. This includes 178 primary care physicians (PCPs) and 201 specialists. Of the 201 specialist providers, 34 are Aexcel designated. A listing of these participating physicians is included with this communication.

 

 

There are 351 participating physicians who have exclusive admitting privileges to a WellStar Health System hospital. This includes 96 primary care physicians (PCPs) and 255 specialists. Of the 255 specialist providers, 66 are Aexcel designated. A listing of these participating physicians is included with this communication. We will be working to keep in-network those physicians who gain privileges at other Aetna participating hospitals.

 

 

Alternate Hospitals available

 

A listing of alternate participating hospitals in the area where employees and their dependents can continue to access care is included with this communication.

 

 

WellStar Health System may terminate their contract for the following product(s):

 

 

  • HMO
  • Aetna Open Access® HMO
  • Quality Point-of-Service® (QPOS®)
  • Aetna Choice® POS
  • Aetna Health Network OptionSM (HNO)
  • Aetna Health Network OnlySM (HNO)
  • Aetna MedicareSM Plan (HMO)
  • Aetna MedicareSM Plan (PPO)
  • Managed Choice® POS
  • Aetna Choice® POS II
  • Aetna Open Access® Managed Choice® POS
  • Elect Choice® EPO
  • Aetna Open Access® Elect Choice® EPO
  • Aetna SelectSM
  • Open Access Aetna SelectSM
  • Open Choice® PPO
  • Aetna Healthfund®
  • National Advantage™ Program

 

Member letters

 

We sent letters to the following employees and their dependents:

 

  • Employees and their dependents who have been treated by a Primary Care Physician at least once in the past 12 months.
  • Employees and their dependents who have selected a Primary Care Physician.
  • Employees and their dependents who have been treated by a specialist provider at least twice in the past 12 months.
  • Employees and their dependents who have utilized the terminating hospital at least twice in the past 12 months.

 

We will help with transition of care

 

Aetna’s standard transition of care policy will apply to members actively in a course of treatment. If any of your employees will require frequent or continuing consultation with a specialist physician for ongoing covered care, the employee should contact his or her current PCP who can help arrange transfer of that care to a similar specialist in the Aetna network. If the member does not have a relationship with a PCP, the member should check DocFind® and other available resources to help find another specialist in the Aetna Network. In addition, we want to help maintain continuity of care coverage if any of your employees are currently undergoing treatment for serious illness, pregnancy or injury with a specialist affiliated with the affected facility. In such an instance, our National Precertification clinical staff will review these cases and, when necessary, offer assistance to members who require transition of care coverage by directing the member to Aetna Member Services or DocFind. For a limited time and when appropriate, Aetna will cover certain ongoing medical care for a serious illness for a specified period at the preferred level of benefits, rendered by a specialist who no longer participates in the network.

 

 

DocFind/directory information

 

We will remove the WellStar Health System hospitals from our DocFindÒ online directory at the next scheduled update, after the contract is terminated. Physicians that have not obtained admitting privileges at another participating hospital on or before the termination date will also be removed from DocFind during the same update cycle. Current printed provider directories include the WellStar Health System hospitals. These Hospitals will be removed from the next directory edition. DocFind is updated nightly, and is the most current source of participating physician and hospital information.

 

 

Please let us know if you have any questions, or if you need additional information. We appreciate your support as we continue to try to address the rising cost of health care services for Atlanta GA area employers and residents. We will continue to keep you informed of any changes in our local network.

 

 

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This has happened several times and the contract is almost always signed. They negotiate down to the bitter end. My doctor's also felt it would be signed.

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It is your Dr/Hospitals deciding to "Divorce" Aetna due to the amounts allowed for certain services is decresing. With Healthcare reform, renegotiation has become an everyday thing. HCR will limit the amount a service can cost (if anything at all). Doctors are not happy about this and it seems that your Dr and Aetna seem to have hit a rough patch.

Talk to Aetna re: the renegotiation of their contract with Tanner and Wellstar. See if this is temp or perm (most times it's temp until the exact details are ironed out)

 

GOOD LUCK :drinks:

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Here is a notice that Aetna sent out to some of the employers they have contracts with, which sheds a little light on what's going on: Network Update

 

 

July 27, 2012

 

 

WellStar Health System (WellStar Cobb Hospital, WellStar Douglas Hospital, WellStar Kennestone Hospital, WellStar Paulding Hospital, and WellStar Windy Hill Hospital) with locations in Cobb, Douglas, and Paulding Counties, GA may terminate from our Atlanta GA Aetna network effective August 31, 2012

 

 

Highlights

 

 

  • Our contract with WellStar Health System (WellStar Cobb Hospital, WellStar Douglas Hospital, WellStar Kennestone Hospital, WellStar Paulding Hospital, and WellStar Windy Hill Hospital) has a scheduled 8/31/2012 termination date.

  • Aetna and WellStar have been in negotiations for a new contract.
  • WellStar is requesting a significant rate increase for their new contract.
  • We continue to work very closely with WellStar towards reaching an agreement that is in the best financial interest of our members, customers and Aetna prior to the termination date.

  • Negotiating reimbursement rates with health care providers is a key component to controlling costs that is directly connected to our ability to provide affordable health care coverage for our members.
  • All services provided by the WellStar hospitals are available at alternate participating hospitals.
  • Medicare member letters were mailed the week of July 1st in compliance with CMS guidelines.
  • Commercial member letters will be generated and mailed the week of July 30th.

 

Hospital Locations

 

WellStar Cobb Hospital

 

3950 Austell Road

 

Austell, GA 30106

 

 

WellStar Douglas Hospital

 

8954 Hospital Drive

 

Douglasville, GA 30134

 

 

WellStar Kennestone Hospital

 

677 Church Street Northeast

 

Marietta, GA 30060

 

 

WellStar Paulding Hospital

 

600 West Memorial Drive

 

Dallas, GA 30132

 

 

WellStar Windy Hill Hospital

 

2540 Windy Hill Road

 

Marietta, GA 30067

 

There are 379 WellStar employed physicians who may also terminate effective 08/31/2012. This includes 178 primary care physicians (PCPs) and 201 specialists. Of the 201 specialist providers, 34 are Aexcel designated. A listing of these participating physicians is included with this communication.

 

 

There are 351 participating physicians who have exclusive admitting privileges to a WellStar Health System hospital. This includes 96 primary care physicians (PCPs) and 255 specialists. Of the 255 specialist providers, 66 are Aexcel designated. A listing of these participating physicians is included with this communication. We will be working to keep in-network those physicians who gain privileges at other Aetna participating hospitals.

 

 

Alternate Hospitals available

 

A listing of alternate participating hospitals in the area where employees and their dependents can continue to access care is included with this communication.

 

 

WellStar Health System may terminate their contract for the following product(s):

 

 

  • HMO
  • Aetna Open Access® HMO
  • Quality Point-of-Service® (QPOS®)
  • Aetna Choice® POS
  • Aetna Health Network OptionSM (HNO)
  • Aetna Health Network OnlySM (HNO)
  • Aetna MedicareSM Plan (HMO)
  • Aetna MedicareSM Plan (PPO)
  • Managed Choice® POS
  • Aetna Choice® POS II
  • Aetna Open Access® Managed Choice® POS
  • Elect Choice® EPO
  • Aetna Open Access® Elect Choice® EPO
  • Aetna SelectSM
  • Open Access Aetna SelectSM
  • Open Choice® PPO
  • Aetna Healthfund®
  • National Advantage™ Program

 

Member letters

 

We sent letters to the following employees and their dependents:

 

  • Employees and their dependents who have been treated by a Primary Care Physician at least once in the past 12 months.
  • Employees and their dependents who have selected a Primary Care Physician.
  • Employees and their dependents who have been treated by a specialist provider at least twice in the past 12 months.
  • Employees and their dependents who have utilized the terminating hospital at least twice in the past 12 months.

 

We will help with transition of care

 

Aetna’s standard transition of care policy will apply to members actively in a course of treatment. If any of your employees will require frequent or continuing consultation with a specialist physician for ongoing covered care, the employee should contact his or her current PCP who can help arrange transfer of that care to a similar specialist in the Aetna network. If the member does not have a relationship with a PCP, the member should check DocFind® and other available resources to help find another specialist in the Aetna Network. In addition, we want to help maintain continuity of care coverage if any of your employees are currently undergoing treatment for serious illness, pregnancy or injury with a specialist affiliated with the affected facility. In such an instance, our National Precertification clinical staff will review these cases and, when necessary, offer assistance to members who require transition of care coverage by directing the member to Aetna Member Services or DocFind. For a limited time and when appropriate, Aetna will cover certain ongoing medical care for a serious illness for a specified period at the preferred level of benefits, rendered by a specialist who no longer participates in the network.

 

 

DocFind/directory information

 

We will remove the WellStar Health System hospitals from our DocFindÒ online directory at the next scheduled update, after the contract is terminated. Physicians that have not obtained admitting privileges at another participating hospital on or before the termination date will also be removed from DocFind during the same update cycle. Current printed provider directories include the WellStar Health System hospitals. These Hospitals will be removed from the next directory edition. DocFind is updated nightly, and is the most current source of participating physician and hospital information.

 

 

Please let us know if you have any questions, or if you need additional information. We appreciate your support as we continue to try to address the rising cost of health care services for Atlanta GA area employers and residents. We will continue to keep you informed of any changes in our local network.

 

 

 

I had someone explain this to me yesterday.

That these form letters are required by law to be sent out until the contract has been signed to renew with the network.

It basically is a warning to people that there could be changes not that those changes have occurred.

 

Well star and Aetna expect to come to agreement before the deadline. More than likely you will not need to look for another doctor.

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