St. Louis patients in limbo as BJC, Aetna remain at odds in coverage talks

ST. LOUIS — BJC Health and health insurer Aetna have yet to reach coverage agreements for the upcoming year, leaving St. Louis-area patients in limbo.

Without a new agreement, BJC Health will be out of Aetna's coverage network employer-sponsored commercial plans, starting Jan. 1.

The ongoing talks affect patients in BJC's eastern region, as well as BJC's facilities in western Missouri operating as St. Luke's Health System. That system is not connected to St. Luke's Hospital in the St. Louis area.

"We continue to negotiate with BJC Health System & Saint Luke’s Health System in good faith with the goal of reaching a fair agreement that keeps them in our network," said Monica Prinzing, a spokesperson for CVS Health, which owns the Aetna Life Insurance Company, in a statement.

BJC Health didn't respond to requests for comment this week but has said in the past that BJC and Aetna were in active negotiations. Neither side has detailed sticking points.

"BJC is eager to finalize an agreement that is beneficial to patients," Laura High, spokesperson for BJC, said in a statement last month.

The stalemate is affecting businesses in Missouri. Aetna controlled over 8% of the market for large employer group comprehensive medical expense insurance in 2023, according to state figures. It had about 2.5% of the individual Medicare Advantage market.

Laurel Pickering, the president and CEO of the Gateway Business Health Coalition, whose members include employers that buy health insurance, said she's heard from one St. Louis-area business that already started open enrollment and only offers Aetna coverage to its 500-plus employees.

"It's too late for them to change anything," Pickering said. Employees were concerned about whether BJC and its physicians would be in-network.

"As the employer you are in a bad position because you don't know the answer and you're trying to allay the concerns and the anxiety of your employees that" may be under current care that will have to continue into the new year, Pickering said.

Without an agreement, BJC will also be out-of-network for Aetna's Medicare Advantage customers, too.

The impasse is just the latest example of health care providers and insurers taking contract negotiations to the 11th hour in the St. Louis area.

The Mercy health care system and Anthem Blue Cross Blue Shield, for example, announced a deal extending coverage for over 2 million Missourians in early December last year, less than a month before Mercy was scheduled to be dropped from Anthem’s network if no agreement was reached.

BJC and Cigna Healthcare in July struck a deal to extend coverage, but only after an impasse disrupted care for some St. Louis-area patients.

A dispute in mid-Missouri shows what can happen when thousands of patients find themselves without coverage at a major regional provider.

MU HealthCare was dropped from Anthem Blue Cross Blue Shield’s network as of April 1.

After that, MU’s competitors in central Missouri have seen increased demand, the Jefferson City News Tribune reported.

The disagreement — affecting 90,000 people — prompted a Missouri Senate committee hearing in June in which senators encouraged both sides to make a deal. A deal was reached in July to restore coverage.

St. Louis-area patients in limbo as BJC, Cigna extend negotiations through July

It's the latest example of health insurers and health providers taking contract negotiations to the 11th hour.

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A failure by both sides to reach an agreement had left patients in limbo.

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