Coverage ended on Jan. 1 at most Providence facilities after a contract between Aetna and it wasn’t reached in time.
PORTLAND, Ore. — Thousands of Providence patients across Oregon will no longer have in-network coverage after insurance company Aetna and Providence failed to reach a new contract agreement before the Jan. 1 deadline.
Among those affected is Bob Dragoon’s daughter, a 34-year-old mother of two who is battling stomach cancer. The disruption means that her appointments, medications, and treatment plans have been halted.
“Without her care she will suffer, suffer drastically. Her children will suffer. This is not something that can go on for very long,” Dragoon said.
The dispute between Aetna and Providence centers on pricing. Aetna claims that Providence is demanding price hikes above market rates to renew their contract, which would then lead to higher premiums for Aetna policyholders. Aetna provided this statement when contacted by KGW:
“Providence has terminated our network agreement and is demanding price increases higher than the market rate to renew. Agreeing to these demands from Providence would create financial burden for local families and businesses as more than 85% of our Oregon members are in self-funded health plans paid for by local employers. These higher prices would lead to substantially higher out-of-pocket costs, deductibles, and copayments for our members and impact local employers and small businesses as well. We want to reach an agreement that brings Providence back into our networks and have offered them market competitive rate increases, but we cannot agree to terms that would burden local businesses and their employees with significant cost increases.”
Providence says Aetna is to blame for the drop in coverage. A spokesperson provided this statement about the situation:
Our contract with Aetna insurance has expired. Other insurers have agreed to step up and share in the increasing costs of health care, but Aetna has not been willing to do so. For now, Aetna members will be seen at out-of-network rates effective Jan.1, with the exception of our PMG clinics and providers in southern Oregon. That contract runs through Feb. 16.”
According to Providence, Providence employees will not see their coverage impacted despite Aetna being its benefits administrator.
Dragoon doesn’t understand why a deal hasn’t been reached, “What is getting in the way? Is it the profit margin? Is it the escalating cost of care that can’t be reigned in some other way? To have our daughter at the end of this string, being manipulated and pulled in such a way that she can’t get her treatments is tearing us down.”
