An Email You Should Actually Read: Aetna and Continuum Part Ways
Written by Bwog Staff
There have been lots of health care changes in the past few months. Yesterday, they got even more local.
If you are on the Columbia health care plan, like almost all of you are, you are covered by Aetna Student Health. Aetna is the company that makes sure you don’t have to pay a lot of money for a real-doctor or hospital visit after the folks in John Jay tell you to take two Advil and suck it up, is experiencing some changes. Over two months ago, on April 5, Continuum Health Partners (which includes St. Lukes Hospital, Roosevelt Hospital, Beth Israel Medical Center – Petrie Division, Beth Israel Medical Center – Kings Highway Division, New York Eye & Ear Infirmary, and Long Island College Hospital) “terminated its relationship with Aetna.” You will have all gotten a rather long-winded email about this in the last day or two.
But what does it mean? If you go to the hospitals in Continuum (that’s after August 5, you will have to pay a whole lot more for whatever help you get there than you would have last year. Hospitals not included in Continuum will still be covered by Aetna, as will 80% of emergency services at all hospitals. You may still be eligible for “transitional services,” which depends entirely on the Continuum hospitals accepting the same rates that were in place before this change, and the hospitals accepting your request for transitional coverage.
So this is a big deal, and we have some questions. How likely is it that these transitional services will be granted, and for how long? Are there any other changes afoot? How much can we expect to pay for a CAVA call next year? We called Health Services to try to figure this stuff out, but they referred us to a “Media Request Form” that Bwog is filling out now. We’ll update you if and when we get answers.
Update, 6/25: At last, a response from Health Services. Doesn’t tell you much that’s not in the email, but take a look:
Health Services recognizes and shares students’ concerns about the message sent by Aetna Student Health on the contract termination between Aetna and Continuum Health Partners. The notice was intended to provide information on care that a student may receive at a Continuum hospital, laboratory or outpatient clinic.
Please be assured that students’ insurance coverage has not been terminated. Also please note that services provided by Continuum physicians within the Aetna Student Health network are not affected by this change.
Services provided by Continuum facilities including hospitals, labs and radiology are still covered by Aetna, but at the lower out-of-network rate. This may increase out-of-pocket expenses, and students should keep that in mind if they receive care at any of the Continuum sites listed. We regret that we cannot be more precise about the effects on out-of-pocket costs, but the terms are still being negotiated by Continuum and Aetna. Students have the option of seeking services at other facilities within the Aetna network. Students can find alternatives by linking to the Aetna Student Health “Docfind” site from the insurance section of the Health Services website at www.health.columbia.edu. As always, it’s recommended that students verify their financial responsibility for services in advance.
Read the full email from Aetna after the jump.
Dear Valued Member:
Hospital agreement terminated on April 5, 2010
Continuum Health Partners, which includes St Lukes Hospital, Roosevelt Hospital, Beth Israel Medical Center – Petrie Division, Beth Israel Medical Center – Kings Highway Division, New York Eye & Ear Infirmary, and Long Island College Hospital terminated its relationship with Aetna effective April 5, 2010.
However, both parties agreed to a two-month cooling-off period following the termination date. The expiration of the cooling off period was June 5, 2010. An agreement was not reached and Continuum Health Partner Hospitals (including all facilities listed above) will be now considered out-of-network for Aetna members.
Continuum maintains separate contracts with facilities (i.e., hospitals) and providers (i.e., doctors). It is important to note that this termination applies to the facilities listed above and services rendered at these locations. You may still seek services from Aetna providers regardless of their Continuum affiliation until at least August 5, 2010.If hospital services are needed, please work with your doctor to find an Aetna participating hospital to render those services. Seeking care from a participating provider will help you get the most out of your benefits plan.
What this means for you
After 6/5/2010, except for preauthorized services or unless you qualify for coverage of transitional services (see below) your “out-of-pocket” cost for services at Continuum facilities will likely increase.
The provision of transitional care is dependent on the above hospitals: (1) accepting reimbursement at the rates in effect onApril 5, 2010, and (2) agreeing to comply with the plan’s policies and procedures, including those governing quality assurance. You or your doctor will need to complete a Transition Coverage Request form and send it to us. To request this form, contact Aetna Student Health Customer Service at the number listed on your ID card.
To qualify for transitional care as a pregnant member, you must have entered the second trimester of pregnancy as of the April 5, 2010 termination date. If you meet this criterion, you may continue to get treatment from Continuum Health Partners for a transitional period that includes postpartum care directly related to the delivery of your baby. You or your doctor will also need to complete a Transition Coverage Request form and send it to us.
Emergency services are covered at these hospitals
In an emergency, you should go to the closest emergency department for treatment. Emergency services will be covered, even if the facility is not part of Aetna’s network. Please note that, for students enrolled in the basic level of Columbia University’s student health insurance plan, emergency room services are covered at 80%, for both the preferred and non preferred level of care and you may have increased out of pocket costs.
Contact us if you have questions
We apologize for any inconvenience this change may cause. We value you as a member and will continue to meet your health care coverage needs. If you have questions, please contact Aetna Student Health Customer Service at 800-859-8471.
You may also wish to contact your on-campus Insurance Office at 212-854-3286 or visit the office in Wien Hall, Monday through Friday 9am to 5pm.
Aetna Student Health