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After Aetna fires Rush, Rush drops Aetna

The change comes after Aetna late last year canceled its contract with Rush to provide care to Aetna patients, effective January 1. Rush refused to accept a roughly 30 percent cut in reimbursement rates.

August 28, 2012

Rush System for Health has dropped Aetna Inc. and picked Cigna Corp. to administer its employee health plan, avoiding the awkward situation in which Rush would have been an out-of-network provider to its own workers.

The change comes after Aetna late last year canceled its contract with Rush to provide care to Aetna patients, effective January 1. Rush refused to accept a roughly 30 percent cut in reimbursement rates, said Brent Estes, vice president of the Rush system, which includes Rush University Medical Center on the Near West Side, Rush-Copley Medical Center in Aurora and Rush Oak Park Hospital.

Estes said he didn't know how many Rush patients are covered by Aetna, but added, "There will be disruption."

Aetna, a Hartford, Connecticut-based health insurer, is the fifth-largest accident and health insurer in the state, according to the National Association of Insurance Commissioners, a Kansas City, Missouri-based, nonprofit group of state insurance regulators.

Aetna also administered Rush's health plan, which covers about 17,000 workers and their family members. Rush's termination meant that the health care system would not have been the in-network provider to its own employees, Estes said.

Patients typically have to pay out of pocket to go to out-of-network health care providers.

Aetna had managed the plan for four years.

In a statement, Aetna said it is seeking a competitive contract with Rush, in line with similar health systems.

"Negotiations between health systems and insurance companies are often lengthy processes and agreements can be made (at) any stage along the way," the statement said. "We would like to continue talks with Rush and are hopeful an agreement can be reached that would allow them to remain in our network at year's end."

Cigna and Rush about a month ago also renewed a long-standing network provider agreement for three years that allows Cigna patients to continue receiving in-network care with Rush hospitals and physicians.

Bloomfield, Connecticut-based Cigna has 400,000 customers in Illinois, according to a spokeswoman, although she would not say how many live in the Chicago area.

"Cigna is proud to be working with Rush to provide a leading-edge health plan for employees," Sue Podbielski, Cigna president for Midwest markets, said in a news release. "As we welcome our new customers, our focus is on providing them reliable, responsive and personalized customer service, with individualized health care programs that help them achieve their personal health goals."

Cigna is the eighth-largest accident and health insurer in the state, according to the NAIC.

Because Rush is self-insured, Cigna's role will be processing claims and managing how patients use services, Estes said. Rush and Cigna plan to collaborate on a model of care that would improve quality and patient outcomes while reducing costs.

Filed by Kristen Schorsch of Crain's Chicago Business, a sister publication of Workforce Management. To comment, email editors@workforce.com.

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