Frequently Asked Questions
Pediatrix’s medical practices have had a long-standing in-network relationship with CVS Aetna, and we have attempted to engage collaboratively with them for over [a year / two years] on a contract renewal that will enable Pediatrix to remain a participating provider with CVS Aetna’s [Texas / California] plans. Unfortunately, it is now our understanding that our [Texas / California] agreement with CVS Aetna will be terminated as of June 30, 2021. As a result, unless something changes, CVS Aetna’s [Texas / California] plans will no longer cover Pediatrix as in-network for many essential services, effective July 1, 2021.
It is important to note that, for now, nothing changes for our patients. Pediatrix will remain a participating provider with CVS Aetna’s [Texas / California] plans through June 30, 2021, and you and your family can continue to receive all services provided by Pediatrix on an in-network basis.
We have been and are committed to working in good faith to renew our provider agreement with CVS Aetna, and remain hopeful that continued negotiations will result in a new agreement before June 30, 2021. We will continue to keep you informed of new developments.
Pediatrix’s medical practices have had a long-standing in-network relationship with Aetna, and we have been working collaboratively for many months with Aetna’s Texas team on our contract renewal. We reached an agreement on key terms a month ago, but Aetna’s Corporate team is currently delaying the finalization of the renewal agreement. We regret this decision by Aetna, especially as it affects the ability of our Texas patients to receive in-network care, and remain hopeful that Aetna will reconsider before our current agreement expires on September 7th. We remain committed to working in good faith with Aetna to reach an agreement that minimizes disruption to our patients’ care.
Renegotiations of contracts between physician groups and insurance companies/payors are a standard part of doing business. We approached this negotiation in good faith, as we have with Aetna and other payors in the past, with the goal of reaching a fair agreement that would ensure adequate coverage of costs for our patients and our providers. We had in fact reached an agreement in principle with Aetna’s local group in Texas, when Aetna Corporate intervened and prevented the agreement from being finalized.
Our number one priority is providing high-quality care, regardless of payor, and we are committed to engaging in good faith with Aetna and other insurance carriers in order to allow our patients to receive high-quality in-network care as part of their insurance plans. We hope that Aetna’s Corporate team will allow our discussions to resume before the agreement expires on September 7th.
If not extended or renewed by September 7th, the current agreement expires on September 8th, 2020.
Nothing changes for patients with Aetna health plans before September 8th, 2020. You will continue to receive the same quality care from Pediatrix providers at in-network rates without disruption. However, if Aetna is unwilling to work with Pediatrix in a reasonable way to reach an agreement, Pediatrix may be forced out of network, and you may be forced to pay higher out-of-pocket costs when receiving care from our providers from September 8th, 2020, onward.
Certain patients, including those hospitalized, pregnant, or undergoing an active course of treatment before the contract end date, may qualify for Continuity of Care through Aetna. If you think you may be eligible, call the phone number on the back of your Aetna health insurance card today to request a Continuity of Care form and apply.
Your employer is best suited to answer this question. A health insurer is required by law to provide an adequate coverage network for many healthcare services. By not including Pediatrix in its network, Aetna could create a gap in coverage of pediatric subspecialty services.
These negotiations directly impact all patients covered by Aetna health plans. If Pediatrix and Aetna are unable to reach an agreement, and Pediatrix goes out of network, Aetna members may have to pay higher out-of-pocket costs for care received from Pediatrix providers, effective September 8th, 2020.
All practice locations in Texas where Pediatrix provides services are impacted by the negotiations.
It’s important to know that, for now, nothing changes. You can continue to receive the same quality care from Pediatrix providers at in-network rates without disruption. However, if Aetna is unwilling to work with Pediatrix to reach a fair agreement, Pediatrix may be forced out of network, and you may be forced to pay higher out-of-pocket costs when receiving care from our Pediatrix providers, effective September 8th, 2020.
Yes. And it’s important to know that, for now, you can continue to receive the same quality care from Pediatrix providers at in-network rates. However, if we cannot reach a fair agreement by September 7th, and you remain on an Aetna insurance plan, your plan will no longer cover Pediatrix providers in-network. While you can still receive the same essential care from our providers, you may be forced to pay higher out-of-pocket costs, effective September 8, 2020.
For now, your billing will not change. However, if Aetna is unwilling to work with Pediatrix to reach a fair agreement before September 7th, 2020, you may be forced to pay higher out-of-pocket costs when receiving care from our Pediatrix providers, effective September 8th, 2020.
Along with several other plans, Pediatrix is a participating provider with the following:
- United Healthcare
- BlueCross Blue Shield (BCBS)
- Cigna
- Humana
- MedCost
Pediatrix will continue to keep patients informed on our progress with Aetna’s Corporate team. If you have questions in the meantime, please call their dedicated patient phone line at 214-919-2273.