February 16, 2001

VUMC ends contract with Aetna Healthcare

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Dr. Dan M. Roden will use a $500,000 grant to study pharmacogenomics. (photo by Dana Johnson)

VUMC ends contract with Aetna Healthcare

Effective March 1, Vanderbilt University Medical Center will no longer be under contract with Aetna US Healthcare.

The decision to end the contract resulted from stalled negotiations over minimal payments from the insurance company.

According to Norman Urmy, executive vice president for Clinical Affairs, the payments offered by Aetna/Prudential were substantially lower than other insurers. “They were our worst commercial contract,” Urmy said.

“We very much wanted to continue serving Aetna and Prudential patients. We believe we have negotiated in good faith, but their final proposal still left them substantially below all other commercial contracts,” said Dr. Harry Jacobson, vice chancellor for Health Affairs.

Aetna represented about five percent of VUMC’s total activity and the medical center is doing a number of things to counteract any potential negative effect of this termination.

Steps being taken include:

• Meeting with all major employers to explain Vanderbilt’s position and to reinforce the desire to work with them and care for their employees. Major employers will be asked to consider holding a special open enrollment period to allow their Aetna members to select a new managed care plan that offers Vanderbilt as a choice;

• Notifying all Aetna patients currently receiving care at Vanderbilt of this termination; and cslosely monitoring all Aetna patients who come to Vanderbilt for treatment. Under continuity of care provisions, physicians will be able to continue seeing Aetna patients for their current episode of care.

Aetna has assured its members that Vanderbilt will remain available for pediatrics, high-risk OB, and trauma.

“Details of handling these patients will be worked out with Aetna and we will be communicating with the PCC directors and others as soon as they are available,” said Urmy. “We will ask the physician members of Cumberland Pediatric Foundation to alert us to any access problems they experience.

“Through the combination of new open enrollment periods at some large employers, allowing their members to join other plans and the fact that nearly all of our clinics are experiencing increased requests, we believe that the immediate impact will be minimal. We hope to increase our activity with health plans that want to work with us in a long-term partnership.”

Aetna U.S. Healthcare purchased Prudential Healthcare in 1999. The largest local clients of the two providers are: Walmart, HCA, Sears, Bell South, Gannett News, State of Tennessee, Saturn, Genesco, AT&T, Lifeway, and Metro Board of Education.