Dive Brief:
- Aetna has filed a lawsuit seeking an emergency hearing regarding Pennsylvania-based Highmark's decision to terminate its provider contract for Jefferson Hospital on December 31, 2014—a date that Aetna says is a year short of the date named by the state Insurance Department when it approved Highmark's purchase of West Penn Allegheny Health System in 2013.
- The suit also names the state Insurance Department, which only "encouraged" Highmark to rescind its notice of contract termination. Said Aetna in its Nov. 25 filing: "The DOI's refusal to enforce the terms of its own 2013 order is contrary to law, arbitrary and capricious and an abuse of the authority delegated to the DOI."
- According to Aetna, "numerous" members have already purchased coverage that they believe includes Jefferson Hospital in-network, including members who have purchased plans through local affiliates HealthAmerica PA Inc. and Coventry Healthcare.
Dive Insight:
Highmark notified Aetna in July that it would not renew its contract past the close of 2014. This is a pretty big deal for Aetna, because it takes away one of the company's biggest competitive advantages in an increasingly-competitive market. Up until now, almost all area hospitals were available to Aetna members, a ubiquity that neither Highmark nor UPMC can claim. Now, if Highmark is allowed to proceed with its contract termination, Jefferson will be out-of-network for Aetna's customers.