Aetna, Rush end contract dispute

Rush System for Health and Aetna have inked a three-year contract that will keep the health care provider's hospitals and doctors in the insurance company's network, Crain's has learned.

Aetna indicated in late 2011 that it would end its contract with the Chicago hospital system, effective Jan. 1. The cancellation came after Rush executives said they refused to accept a roughly 30 percent cut in reimbursement rates. Rush in turn dropped Aetna in August as the administrator of its own employee health plan.

Had the two parties not signed a deal, Aetna members would have had to change to providers in the Aetna network or remain with Rush providers, but pay from their own pockets at prices higher than in-network rates.

“Rush and Aetna have reached agreement on a contract which will result in the Rush System for Health (Hospitals and Physicians) remaining in the Aetna network without any interruption in network participation status,” an Aetna spokesman said in a statement.

Rush Vice President Brent Estes told employees of the system in a Tuesday email that “we are pleased that we have been able to reach an agreement that is mutually satisfactory to both Aetna and Rush.”

“We look forward to continuing our long-standing relationship with Aetna and are extremely pleased that our Aetna patients can continue to receive full service at Rush and from Rush physicians,” Mr. Estes wrote in the email.

The Aetna spokesman declined to comment on any change in reimbursement rates included in the new contract.

Rush receives about 42 percent of its gross patient revenue from private insurance companies, though the bulk of that payment comes from the state's largest health insurer, Blue Cross & Blue Shield of Illinois. Contract negotiations typically center on rates to be paid for services, with providers pushing for higher payment and insurers seeking deeper discounts.

Aetna is the fifth-largest health insurer in Illinois, with about 3.1 percent of the market, according to an August report on managed-care markets by Boston-based CitiGroup Inc. analyst Carl McDonald.

After Rush dropped Aetna as the administrator of its employee plan, it granted that contract to Cigna Corp., the state's fourth-largest insurer. That work is set to start Jan. 1.

The Rush System includes Rush University Medical Center on the Near West Side, Rush-Copley Medical Center in Aurora and Rush Oak Park Hospital.



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