Aetna ends agreement with Keystone Health

Jan. 24--CHAMBERSBURG -- Thousands of local Medical Assistance patients will have to switch health plans or find a new doctor.

Aetna Better Health is ending its agreement with Chambersburg-based Keystone Health Center.

Keystone has about 11,000 patients enrolled in the plan, and this would mark the second time in a year that patients would have to switch plans.

Patients enrolled in the Aetna plan after UPMC ended its agreement with Keystone on Jan. 1, 2014. In June, Aetna notified Keystone it was terminating its agreement effective Feb. 1, 2015.

In a letter, the company did not cite a reason for the termination.

Aetna sent a letter to members indicating Keystone patients would have to find a new doctor or choose a new health plan by Feb. 14.

This has put some families in a bind.

"We can't switch. We are really in between a rock and a hard place," said Karen Shubert of Fayetteville, whose 5-year-old daughter is a patient at Keystone Pediatrics.

Her daughter has two rare medical conditions which require visits to a number of specialists -- the majority of whom do not take the other insurance option.

"We have so much that has already been pre-authorized and we fought so many battles," Shubert said. "We're going to have to stick with Aetna, but then the biggest wrench thrown in all of that is Keystone Pediatrics has managed her care for years, so they know her in and out. From the research I've done, we don't have a lot of pediatricians locally we can take her to if we have to leave Keystone."

In Franklin County, most Medical Assistance consumers under the state's managed care system are enrolled in Aetna Better Health.

Keystone Health targets medically undeserved populations -- such as Medical Assistance patients -- and is the sole provider of pediatric, crisis intervention and infectious disease services.

"Because Keystone does not have a contract with Aetna, our network is greatly compromised," said Keystone President and CEO Joanne Cochran. "We don't have an adequate network anymore."

Keystone has about 11,000 Medical Assistance patients enrolled in the Aetna plan. Summit Health also has an estimated 4,000 patients enrolled, according to Patty Kaufman, Summit's director of managed care.

Aetna notified Summit Health in May it was terminating its agreement with Summit, but then sent a letter in July rescinding the termination.

If Keystone's contract is not reinstated, it will also impact Aetna Better Health subscribers who use certain Keystone services while in the hospital.

Keystone must have an association with a hospital in order to care for their patients who need inpatient hospitalization. And Because Keystone is the only practice of pediatrics, infectious disease, and crisis management in Franklin County, when inpatients at Chambersburg Hospital need a pediatrician or an infectious disease specialist, they need to have a Keystone Health doctor provide that service in-hospital.

"With over 11,000 Keystone Health members covered by Aetna Better Health, these folks need to either transfer their insurance to another company or their family doctor to a Summit Health doctor," said Kimberly Rzomp, Summit Health vice president and CFO. "Summit Health does not have the capacity to absorb 11,000 people at one time into their family practices. With only a few weeks to make this change, transferring 11,000 people to another health insurance company is almost an impossible burden for those people and the health system."

The Aetna plan is one of the plans available to local Medical Assistance enrollees under the state's mandatory managed care system, which was expanded in 2012 to include Franklin County and other counties.

Jim Willshier, policy and public partnership director for the Pennsylvania Association of Community Health Centers, said there was a similar situation last year when Aetna terminated an agreement with a Philadelphia area community health center.

He said the concern in Franklin County is the number of providers that would be available to Aetna's Medical Assistance subscribers if Keystone is taken out of the picture.

"It's a concern because we want to make sure there's adequate access to care for any individual that subscribes to a particular plan," Willshier said. "Part of the concern is that Keystone is a very sizable provider in the county."

Summit and Keystone officials have reached out to professional organizations, state agencies and elected officials, but this was under the backdrop of an election season, budget battle, and rollout of the state's alternative to Medicaid expansion. Rzomp said that without Keystone Health, "access to care in the community is going to be debilitated."

"It's a huge issue," Cochran said. "The good news is Pat O'Donnell, president of Summit Health, and myself are working together on this issue. We'll work together to try to figure out what is the best solution for our community and patients."

Aetna Better Health patients have until Feb. 14 to make a decision. Keystone Health is encouraging affected patients to contact its enrollment navigators.

Keystone has contracted with another managed care organization, AmeriHealth, and is in the process of contracting with Gateway Health Plan.

A spokesperson for Aetna could not be reached.

Marcus Rauhut can be reached at 262-4752.

___

(c)2015 the Public Opinion (Chambersburg, Pa.)

Visit the Public Opinion (Chambersburg, Pa.) at www.publicopiniononline.com

Distributed by Tribune Content Agency, LLC