Midlands hospital, health care providers could be dropped by big insurer. What we know
Customers of a Midlands health care system could be at risk of losing their in-network coverage, depending on the outcome of ongoing negotiations with one of the nation’s largest insurance companies.
Lexington Medical Center this week sent out a notification to all of its patients who have Aetna insurance that the West Columbia-based health care provider could be dropped as an in-network option for the insurance giant.
“Lexington Medical Center is currently in negotiations with Aetna Healthcare on its commercial contract set to terminate on February 1, 2025,” the medical center said in a message sent to patients. “We are diligently working in good faith to remain an in-network provider with Aetna Healthcare, but our status is doubtful.”
The message was sent, Lexington Medical Center said, so that patients can consider making different selections for the health care coverage for the coming year.
“We know many of you are going through open enrollment with your employer and want to make the most informed decision when selecting health care coverage, which is why we are letting you know now,” the message said.
Besides its West Columbia hospital near Interstate 26, Lexington Medical Center operates 44 separate practices and specialists throughout the Midlands, from oncologists to podiatrists to urgent cares. All of them would be affected if negotiations between the health provider and the insurer don’t come to some kind of resolution.
While Lexington Medical Center said it would continue to serve Aetna customers, “you may be subject to the out-of-network terms of your health plan, which generally results in higher out-of-pocket costs to you,” it said.
The center offers financial assistance programs for patients, and ongoing treatments may be eligible for continuity of care during a transitional period while customers find another provider. Emergency services will also continue to be treated as in-network, the medical center said.
Asked for comment by The State, a Lexington Medical Center spokesperson said in a statement, “We are working to remain an in-network provider with Aetna Healthcare, and we hope to reach a mutually beneficial agreement to care for the patients we serve.”
In a statement sent via email, a spokesperson for Aetna’s parent company CVS Health said the company was likewise working to renew its contract with Lexington Medical.
”We are hopeful that we will reach an agreement that keeps them in our networks while keeping health care services affordable for our members and health plan sponsors,” the company said.
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