Coverage ended for most Providence facilities on Jan. 1 because the contract with Aetna was not concluded in time.
PORTLAND, Ore. — Thousands of Providence patients across Oregon will lose access to in-network insurance after insurers Aetna and Providence failed to reach a new contract agreement by a Jan. 1 deadline.
Among those affected is Bob Dragoon’s daughter, a 34-year-old mother of two who is battling stomach cancer. This disruption means her medical appointments, medications, and treatment plans have been halted.
“Without her care, she will suffer and suffer greatly. Her children will suffer. This cannot last for very long,” Dragoon said.
The dispute between Aetna and Providence centers on pricing. Aetna claims that Providence is demanding above-market rate increases for renewals, which would result in higher premiums for Aetna policyholders. Contacted by KGW, Aetna provided the following statement:
“Providence is terminating network contracts and demanding above-market price increases for renewals. 85% of Oregon members Agreeing to these demands from Providence would place a financial burden on local families and businesses, as these individuals have self-funded health insurance that is paid for by local employers. The soaring prices of employers and small businesses. We want to reach an agreement to bring Providence back into our network, and we have proposed market-competitive rate increases. We cannot agree to terms that would impose significant cost increases on local businesses and their employees.”
Providence blames Aetna for the decrease in coverage. A spokesperson issued the following statement regarding the situation:
Our contract with Aetna Insurance has ended. Other insurers have agreed to step up and cover rising medical costs, but Aetna has not stepped up to the plate. For now, with the exception of PMG clinics and providers in Southern Oregon, Aetna members will receive out-of-network rates for visits starting January 1. That contract runs until February 16th. ”
Providence says that even though Aetna is the benefits administrator, Providence employees will not have their coverage affected.
Dragoon doesn’t understand why they can’t reach an agreement. Is it the profit margin? Is it rising health care costs that cannot be addressed in any other way? It tears us apart that our daughter is at the end of this thread, being manipulated and pulled from getting treatment. ”
