St. Elizabeth's leaving Aetna's network

News-DemocratJune 4, 2013 

Exterior view of St. Elizabeth's Hospital.

TIM VIZER/BND

St. Elizabeth's Hospital in Belleville will be leaving Aetna's network.

The health care insurance provider recently sent letters to those covered under Aetna Life Insurance Co. informing them that the Belleville hospital will drop the provider from its network July 1. The letter did not provide reasons for the termination, but stated, "if you go to this health care professional after this date, it may cost you more."

Clients also were advised to ask their primary care physician for a referral to another physician who is in-network or to see another physician in the same medical group if they are part of the network.

The hospital declined to comment further on the move.

In a statement issued Tuesday afternoon, Melissa A. Sterling, Southern Illinois Division director of marketing, communications and planning for the hospital's parent company, Hospital Sisters Health Systems, said "hospitals routinely engage in payor negotiations to maintain all contracts, and these negotiations take place at the system level. It is our practice to not comment on any ongoing or future negotiations with the insurers, but it is important to note that maintaining contract reimbursement enables hospitals to make improvements and keep technology updated so we can provide the best possible care to our patients."

A spokesman from Aetna could not be reached for comment Tuesday.

This move is coming as another Belleville hospital might soon lose a major health insurance provider. A contract dispute about hospital and physician reimbursement rates between Memorial Hospital in Belleville and United Healthcare is running up against a deadline.

United Healthcare's current contract with Memorial Hospital continues through the end of June, and the insurer's contracts with physicians employed by Memorial Medical Group will expire at the end of August if the contract with the hospital is not renewed.

Memorial Hospital chief financial officer Joe Lanius said the two sides continue to meet.

"We're continuing talks with them and exchanging proposals," Lanius said. "It's a back-and-forth process. They are certainly indicating that they are willing to negotiate with us."

Contact reporter Will Buss at wbuss@bnd.com or 239-2526.

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