Upstate can't reach an agreement with the insurer for higher reimbursement rates.
View full sizeUpstate University Hospital's contract with Aetna expires at midnight Friday, so patients who have that insurance will have to pay more to use the hospital.Syracuse, NY -- Barring a last-minute agreement, Upstate University Hospital in Syracuse and Aetna at midnight Friday will no longer have a new contract, and Aetna customers will have to pay more to use the hospital.
“We will continue to work with University Hospital,” Aetna spokeswoman Susan Millerick said. “They have been in the network for many years, and we would like to have them continue. ... We’ll keep talking to them.”
Hospital spokesman Darryl Geddes confirmed that the impasse remained, but he said the hospital hopes an agreement can be reached.
As of midnight, the hospital will be considered an out-of-network provider. An out-of-network provider is one that has not contracted with an insurance company for reimbursement at a negotiated rate. Patients who go to out-of-network providers must pay more of the bill — and in some cases, the entire bill.
The contract dispute will not affect coverage of emergency services at Upstate.
Millerick estimated that Aetna’s 47,000 members in the region might have to pay 20 percent to 30 percent more for hospital services. The hospital has said Aetna covers fewer than 2 percent of its patients.
Upstate announced earlier this month that it was terminating its contract with Aetna after it could not reach an agreement with the insurer for higher reimbursement rates.
The hospital has asked for a 50 percent increase in reimbursement rates in the first year of a three-year contract. Millerick said the current rates are in line with Aetna’s rates with other hospitals in the area.
Aetna will continue negotiations to reach a “reasonable and realistic agreement” with the hospital, she said.
Reach John Stith at jstith@syracuse.com or 251-5718.