Medford, OR – Thousands of patients across Oregon are facing a significant disruption in their healthcare coverage after Aetna and Providence Health & Services failed to reach a new contract agreement by the January 1 deadline. Among those affected is a 34-year-old mother of two, who is currently battling stomach cancer. The dispute between the insurance company and the healthcare provider has led to a halt in her appointments, medications, and treatment plans, leaving her family worried about her well-being.
The crux of the dispute centers on pricing. Aetna claims that Providence is demanding price increases above market rates to renew their contract, which would ultimately lead to higher premiums for Aetna policyholders. The insurance company asserts that accepting Providence’s demands would place a significant financial burden on local businesses, families, and employees, many of whom are part of self-funded health plans. These increased costs would translate into higher out-of-pocket expenses, including deductibles and copayments.
In a statement provided to local news outlet KGW, Aetna explained: “Providence has terminated our network agreement and is demanding price increases higher than the market rate to renew. Agreeing to these demands from Providence would create a financial burden for local families and businesses as more than 85% of our Oregon members are in self-funded health plans paid for by local employers. These higher prices would lead to substantially higher out-of-pocket costs, deductibles, and copayments for our members and impact local employers and small businesses as well.”
Meanwhile, Providence places the blame squarely on Aetna for the disruption. A spokesperson for the healthcare provider explained that other insurers had been willing to adjust to the rising costs of healthcare, but Aetna had refused. As a result, Aetna members will now be treated at out-of-network rates starting January 1. However, the contract for Providence Medical Group (PMG) clinics and providers in southern Oregon will remain in effect until February 16.
“Other insurers have agreed to step up and share in the increasing costs of healthcare, but Aetna has not been willing to do so,” the Providence spokesperson stated. “For now, Aetna members will be seen at out-of-network rates effective January 1, with the exception of our PMG clinics and providers in southern Oregon. That contract runs through Feb. 16.”
Despite the disruption, Providence assured that its own employees’ coverage would not be affected, despite Aetna acting as the benefits administrator for Providence staff.
The situation has left families like that of Bob Dragoon, whose daughter is currently undergoing cancer treatment, struggling to understand why the contract agreement has broken down. Dragoon, who has watched his daughter’s treatment be interrupted, is frustrated by the lack of resolution.
“What is getting in the way? Is it the profit margin? Is it the escalating cost of care that can’t be reigned in some other way?” Dragoon said. “To have our daughter at the end of this string, being manipulated and pulled in such a way that she can’t get her treatments is tearing us down.”
As the dispute continues, thousands of Oregonians now find themselves caught in the middle, facing out-of-network costs or disruption to their care. The situation raises broader questions about the rising costs of healthcare and the financial challenges faced by both providers and insurers. For now, patients will have to navigate the uncertainty while Aetna and Providence continue their negotiations.