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Cook Children's, Aetna resolve contract dispute

A disagreement over reimbursements was the source of a lengthy impasse

03/27/2013 11:38 PM

03/27/2013 11:38 PM

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

The previous four-year contract 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 dispute was to Medicaid members, who are mostly children. Aetna 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.

Jim Fuquay, 817-390-7552

Twitter: @jimfuquay

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