Cook Children's, Aetna resolve contract dispute

Posted Wednesday, Mar. 27, 2013  comments  Print Reprints

Have more to add? News tip? Tell us

Cook Children's Health Care System and Aetna have resolved their contract dispute, giving the insurer's thousands of Medicaid member's access to Tarrant County's largest provider of pediatric medical services.

The previous four-year contract between the parties ended Nov. 1 last year. The new contract covers treatment dating back to March 1 and has no set expiration date, said Judi Hershman, senior vice president at Cook Children's.

Cook Children's, which includes Tarrant County's specialty pediatric hospital, was dropped from Aetna's network of providers on Nov. 1 because of a disagreement over reimbursements. Some of the 42,500 Medicaid members in the Aetna Better Health network who had been seeing doctors in the Cook physician network had to find another pediatrician or go to another facility for tests or procedures.

Aetna had submitted a new contract proposal on Feb. 7, following a meeting with Cook Children's that was also attended by an official from the Texas Health and Human Services Commission acting as an observer.

Cook Children's accepted some fee changes proposed by Aetna while rejecting some other alterations in terms, Hershman said.

"We kept communication going. We wanted to do the right thing for the children," she said.

Gary Bozeman, chief operating officer of Aetna Better Health in Texas, said in a prepared release that "Aetna is pleased to announce that Cook Children's Hospital will continue to be an important part of our Aetna Better Health Network in North Texas."

Bozeman said the new contract "will allow us to continue offering our members access to a broad network of high-quality hospitals and physicians in North Texas."

Aetna is the smallest of three Medicaid managed care plans in the Tarrant market, which also includes several neighboring counties. Local Medicaid beneficiaries have been in managed-care plans since 1996, when the Tarrant region was part of a state pilot program.

"The doctors see this as a really good thing," said Dr. Sealy Massengill, president of the Tarrant County Medical Society. "We're glad Aetna and the largest pediatrics" system serving the Tarrant area reached an agreement that will allow patients to receive specialized treatment, Massengill said.

It's not clear how disruptive the four-month dispute was to Medicaid members, who are primarily children. Aetna had contracted with Children's Medical Center of Dallas, which has a large Southlake clinic, to provide specialty care, while Cook Children's had said the hospital and its physicians continued to see Aetna members when needed.

Massengill said the Medical Society, which represents local physicians, did not receive a great many calls about the issue.

Hershman said that in some cases, Cook Children's treated Aetna members under special contract agreements. More frequently, she said, Aetna members received authorization to use Cook Children's facilities as out-of-network services, under which its reimbursement was reduced by 5 percent.

Other services delivered to Aetna members after Nov. 1 and before March 1 were not reimbursed, she said.

Jim Fuquay, (817) 390-7552

Twitter: @jimfuquay

Looking for comments?

We welcome your comments on this story, but please be civil. Do not use profanity, hate speech, threats, personal abuse or any device to draw undue attention. Our policy requires those wishing to post here to use their real identity.

Our commenting policy | Facebook commenting FAQ | Why Facebook?