Beginning Jan. 1, ProMedica physicians will be considered out-of-network for commercial Aetna members, who will be billed 100 percent for any services received. Aetna’s Medicare Advantage members will maintain in-network access to the physicians until June 1. Impending network changes could disrupt care the group’s 950 salaried physicians provide to some 27,000 Aetna members.
Rates are a cornerstone of the physicians’ stronghold, as the group said it hasn’t received a rate increase from Aetna in six years. James North, MD, a salaried family practitioner with ProMedica Physicians Group, told The Blade Aetna pays the lowest rates compared to other local and national commercial payers.
Aetna told The Blade Dec. 8 it is “in active negotiations with ProMedica and hope[s] to reach a new contract that is fair and reasonable for our members and the ProMedica System.”
ProMedica hospital and ancillary care will remain covered by Aetna even if a deal collapses.
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