LVHN dropping Aetna insurance coverage

[Northeast Agent]

[EXTERNAL LINK] - LVHN dropping Aetna insurance coverage

This hospital is a big player an hour from me, so now I have some MA clients to move. A MS client just called me in a panic, but she's OK.

LVHN said it is ending its relationship with Aetna because of unpaid bills that have been stacking up since 2017. The health network says Aetna routinely denies and delays claims, despite LVHN trying to resolve these issues.

"We have spent the past five years trying to reach a resolution with Aetna, but they have refused efforts to resolve in good faith," LVHN said in a letter obtained by 69 News. "... Aetna has missed the timeline both parties agreed to, creating further delays, and has failed to pay for care that LVHN has provided to its patients."

 

[somarco]

I assume this is EGH . . .

 

[Northeast Agent]

Somarco said:


I assume this is EGH . . .

I'm curious as to why you think that? A few months ago there was a story about them refusing to pay for cataract surgery on MAPDs.

 

[somarco]

Somarco said:


I assume this is EGH . . .

I'm curious as to why you think that? A few months ago there was a story about them refusing to pay for cataract surgery on MAPDs.

Because LVHN is a hospital . . .

They could be dropping their provider contract with Aetna which (could) include ACA, EGH and MAPD (but not Medigap)

 

[Baseball7]

That carrier was never kind to 911 paramedic services in bucks county.

 

[Northeast Agent]

Somarco said:

They could be dropping their provider contract with Aetna which (could) include ACA, EGH and MAPD (but not Medigap)

Aetna doesn't currenty have ACA in PA. Saw on the news this morning the hospital is dropping them, including Medicare/Medicaid; no mention of EGH.

I posted something not long ago about Aetna taking forever to approve cataract surgeries and wonder if this is just the tip of the iceberg.

 

[somarco]

Saw on the news this morning the hospital is dropping them, including Medicare/Medicaid; no mention of EGH.

When a provider terminates or non-renews an MCO agreement, all managed care products are included. A provider would have legal challenges if they refused to accept Medicare & Medicaid patients but allowed others (such as EGH) to be admitted.

I posted something not long ago about Aetna taking forever to approve cataract surgeries and wonder if this is just the tip of the iceberg.

Possibly, but not necessarily.

A few years ago a prospect contacted me about changing her MAPD PPO plan to OM and Medigap. She had cervical stenosis that had progressed to the point her doc said only surgery would provide relief.

Doc filed prior authorization forms with Aetna, asking permission for the patient to have an MRI. Aetna refused to authorize several times, leading to a 4 month delay . . . and 4 months of endured pain. After viewing the MRI results the doc had to go back to Aetna to get approval for spinal fusion surgery. Again, Aetna denied the request suggesting other treatment such as PT and pain management (even though the patient was receiving this kind of care already and was still in pain. Another 4 months before Aetna approved the surgery . . . which was scheduled and performed about a week later.

When she contacted me about a Medigap plan (as suggested by her doc) there was not way to get underwriting approval due to ongoing treatment and pending surgery. I told her she would have to wait until AFTER the surgery, and a release by her doc.

Almost a year after the time when she first contacted me, it seemed like she was finally going to get the plan she wanted. Going over the health questions I discovered she was on medication for angina and AFIB which would mean the application would be rejected.

This tragedy could have been avoided had she contacted me when her friend (my client) told her to do so. She was turning 65 a few months before when her ortho was discussing surgery as the best solution to her problem. Instead of paying for a Medigap plan she opted to choose a $0 premium plan that not only cost her more $$ but also resulted in 8 months of pain she would not have endured had she started on a Medigap during IEP.

 

[goillini52]

When a provider terminates or non-renews an MCO agreement, all managed care products are included. A provider would have legal challenges if they refused to accept Medicare & Medicaid patients but allowed others (such as EGH) to be admitted.



Possibly, but not necessarily.

A few years ago a prospect contacted me about changing her MAPD PPO plan to OM and Medigap. She had cervical stenosis that had progressed to the point her doc said only surgery would provide relief.

Doc filed prior authorization forms with Aetna, asking permission for the patient to have an MRI. Aetna refused to authorize several times, leading to a 4 month delay . . . and 4 months of endured pain. After viewing the MRI results the doc had to go back to Aetna to get approval for spinal fusion surgery. Again, Aetna denied the request suggesting other treatment such as PT and pain management (even though the patient was receiving this kind of care already and was still in pain. Another 4 months before Aetna approved the surgery . . . which was scheduled and performed about a week later.

When she contacted me about a Medigap plan (as suggested by her doc) there was not way to get underwriting approval due to ongoing treatment and pending surgery. I told her she would have to wait until AFTER the surgery, and a release by her doc.

Almost a year after the time when she first contacted me, it seemed like she was finally going to get the plan she wanted. Going over the health questions I discovered she was on medication for angina and AFIB which would mean the application would be rejected.

This tragedy could have been avoided had she contacted me when her friend (my client) told her to do so. She was turning 65 a few months before when her ortho was discussing surgery as the best solution to her problem. Instead of paying for a Medigap plan she opted to choose a $0 premium plan that not only cost her more $$ but also resulted in 8 months of pain she would not have endured had she started on a Medigap during IEP.

If she's not taking a blood thinner Lumico and ACE will consider her, With ACE, it would also need to be 2 years since she was treated for stenosis.

 

[somarco]

If she's not taking a blood thinner Lumico and ACE will consider her, With ACE, it would also need to be 2 years since she was treated for stenosis.

ACE has only been here since September . . they might be gone before the 2 year wait is over. Elips/Lumico just a tad longer. Neither are competitive but thanks for the info.

 

[goillini52]

ACE has only been here since September . . they might be gone before the 2 year wait is over. Elips/Lumico just a tad longer. Neither are competitive but thanks for the info.

They're both backed by huge companies (ACE/Chubb...Lumico/Swiss RE). They're both very competitive in my area, especially ACE.

The 2 year wait is for ACE, not Lumico.

So, you don't think she'd be better off with ACE or Lumico than she is in a MAPD?