CVS Aetna members in Texas could face out-of-network costs starting July 1 if Sunrise, Fla.-based provider Mednax can't reach a contract renewal agreement with the payer.
Negotiations between the parties began in December 2019, when Mednax subsidiaries Pediatrix Medical Group and Obstetrix Medical Group requested to renegotiate reimbursement rates, the Dallas Morning News reported.
Pediatrix and Obstetrix President Roger Hinson, MD, said the reimbursement cuts Aetna had proposed were not sustainable.
"A draconian cut in your rate is not a negotiation," Dr. Hinson told the publication.
Aetna Vice President Richard Gentleman told the Dallas Morning News that Mednax had requested a 22 percent reimbursement increase during the first round of negotiations. "That roughly equated to about $11 million for our Texas Health Plan. And also they were demanding another one and a half million dollars in other payments to them," he said.
Further negotiations in 2020 failed to yield a contract renewal.
Texas Mednax providers will become out of network for the state's Aetna patients as early as July 1 without an agreement.