Cook Children’s, Aetna take disagreement to mediator [Fort Worth Star-Telegram]
By Jim Fuquay, Fort Worth Star-Telegram | |
McClatchy-Tribune Information Services |
Aetna is the smallest of three
Aetna and
"We want it to be as easy as possible for children to access care," and the state aims "to discuss and hopefully resolve" the stand-off, said HHSC spokeswoman
Dr.
"We're disappointed these two groups can't reconcile their differences," said Massingill, chairman of obstetrics and gynecology at JPS Health Network. "It puts the pediatric population of
It's unclear just how disruptive the dispute has been to patient care.
Aetna has contracted with
Virtually all other
Edwards Gockel said that since
"In each case an Aetna case manager reached out and the complaints were resolved within 30 days," she said. "We will continue to monitor the situation."
In what could be a sign of the impact of the dispute, Aetna since September has lost about 650 members. In that same period,
There is no financial difference to patients. The plans are paid a per capita rate by the state and are then responsible for managing total medical expenses for their members.
Neither Aetna nor
King said Aetna asked "for some things we hadn't been doing before."
But
Sperry said he doesn't know the details of the Aetna-Cook Children's dispute, but said "managed care companies can contract all different ways" for payment of services. For example, he said, one company might seek to pay for members' time in an intensive care unit with a flat rate per day, while a hospital might want to be paid based on a discounted fee schedule.
Twitter: @jimfuquay
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