A Midlands hospital system has been dropped by a major insurance provider. What we know
A major health insurer will drop a Midlands health care system from its network early next year.
Lexington Medical Center confirmed to The State on Monday that the West Columbia hospital and its plethora of services around the Columbia area will no longer be considered in-network with Aetna as of Feb. 1.
“Beginning February 1, 2025, Aetna will no longer consider Lexington Medical Center or its affiliated physician practices as in-network for its commercial or Medicare Advantage plans,” the hospital said in an email. “Even though our network status may change, Aetna-insured patients can still come to Lexington Medical Center, our urgent care facilities, our surgery centers, and our physician practices for their care.”
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 are affected by the decision. Lexington Medical Center had previously warned patients that it was in negotiations with Aetna for next year’s coverage, but that its status was “doubtful,” in case patients wanted to adjust their health coverage for 2025.
Aetna parent company CVS Health told The State in a statement that the company is continuing to work to try to keep Lexington Medical Center facilities and providers within its network, but blamed the health provider for asking for too much in any renewed plan.
“We are continuing to work in good faith to renew our network agreement with Lexington Medical Center,” the insurer said. “However, we remain far apart on terms because of their demand for unreasonable price increases for their services. While we want to reach an agreement that keeps Lexington Medical Center in our network, we cannot agree to terms that would burden our members and local employers with significant cost increases.
“It is unfortunate, but unless we reach a new agreement, Lexington Medical Center will no longer be in network for our Medicare and Commercial health plans after January 31, 2025.”
The hospital network said that health plans with out-of-network benefits will incur out-of-network costs at an LMC provider. Lexington Medical does provide financial assistance programs if the coverage change causes hardship for its patients.
Aetna-insured patients currently receiving ongoing treatments at Lexington Medical Center may qualify for continuity-of-care benefits for certain conditions. The hospital encouraged patients to contact Aetna to check if these benefits would be available to them.
Emergency services at the hospital’s emergency department will continue to be treated as in-network, Lexington Medical said.
This story was originally published December 16, 2024 at 11:30 AM.
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