Aetna insurance plans to submit a new contract proposal next week to Cook Children's Health Care System as the two seek to end a three-month dispute that affects thousands of Medicaid beneficiaries.
The move follows a meeting Thursday between Cook Children's and Aetna that was also attended by a representative from the Texas Health and Human Services Commission, who acted as an observer. Cook Children's, the area's specialty pediatric hospital, and its affiliated doctors were dropped from Aetna's managed-care network effective Nov. 1, when a four-year contract ended.Rich Goode, chief financial officer for Cook Children's, said the hospital hasn't been willing to sign a new contract with Aetna because "we feel the services we're providing and the fees aren't quite aligned yet." He said Aetna simply isn't offering adequate reimbursements to Cook Children's under a traditional fee-for-service system."I'm confident we'll figure something out," Goode said.Aetna spokeswoman Anjanette Coplin said Thursday that "after the meeting today, we decided to send a counterproposal to Cook's next week. We are hopeful that the two sides will be able to reach an agreement."Coplin confirmed that reimbursement rates are the sticking point. She said Aetna isn't asking Cook Children's to take on more risk for patients' expenses or work on a capitated basis, in which the hospital might receive fixed payments for various patients.About 42,500 Medicaid beneficiaries in the Tarrant area are members of Aetna Better Health, the insurer's Medicaid HMO.Aetna has contracted with Children's Medical Center of Dallas, which has a large Southlake clinic, to provide specialty care. Cook Children's says the hospital and its physicians continue to see Aetna members when needed.Local Medicaid beneficiaries have been in managed-care plans since 1996, when the area was part of a pilot program.Jim Fuquay, (817) 390-7552Twitter: @jimfuquayHave more to add? News tip? Tell us
