- 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.
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.