Aetna reaches contract with ER doctors at Allegheny Health Network

Nov. 11--Health insurer Aetna announced Wednesday it negotiated a three-year contract with a group of emergency care physicians at Allegheny Health Network, ending an impasse that had resulted in large medical bills for some customers.

The contract, which runs through 2018, ensures in-network access for Aetna members to Allegheny Health's emergency rooms throughout Western Pennsylvania, including flagship Allegheny General Hospital in the North Side.

The two sides reached an agreement Nov. 1, said Aetna spokesman Walt Cherniak. Patients who were billed by the doctors group won't have to pay the higher amounts in the bills, Cherniak said. Those who paid the higher amounts should contact Aetna, he said.

"Aetna is extremely pleased to have resolved this issue in a timely manner," Jerry Dioguardi, head of Aetna's Western Pennsylvania operations, said in a statement.

The insurer and the doctors group, Ohio-based Emergency Medicine Physicians, had been without a contract since April 2014. Emergency Medicine Physicians said Aetna was not paying a fair amount toward patients' care in the absence of a contract and began billing patients directly in September to make up for it. The doctors group said it billed over 800 patients. Aetna responded by sending letters to about 200,000 patients last month telling them to call the insurer before paying the bills.

"We came to a good number, I think everybody's happy with it and we can move on -- and patients don't have to worry about being out of network," said Dr. David Scott, chief administrative officer of Emergency Medicine Physicians.

The contracted rates will allow the group to hire "the best and brightest docs to give the best care," Scott said. The group provides emergency care as part of a joint venture with Allegheny Health Network, which is owned by Highmark Health.

AHN spokesman Dan Laurent said the network would not disclose whether the network or the doctors group is the majority owner of the joint venture.

Aetna members will be able to get in-network emergency care at seven AHN facilities. In addition to Allegheny General, the hospitals include West Penn in Bloomfield, Allegheny Valley in Natrona Heights, Canonsburg, Forbes in Monroeville, Jefferson in Jefferson Hills and Saint Vincent in Erie.

Wes Venteicher is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or [email protected].

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