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Ellwood City Hospital to eliminate insurer



Published: Sun, November 18, 2001 @ 12:00 a.m.



About 400 people would have to find new doctors if the insurance provider is dropped by the hospital.

ELLWOOD CITY, Pa. -- The cost of doing business in the health-care industry isn't only a problem for health insurance companies.

Ellwood City Hospital has decided to drop Aetna U.S. Healthcare insurance because the company's reimbursement barely covers the costs for patient care, said hospital President Herb Scuba.

He said Aetna U.S. Healthcare Insurance will not be accepted here after June 30, 2002.

"We are canceling our contract. We are not trying to create a crisis here. We have been working for six months to have our reimbursement increased," Scuba said.

Scuba said overall Aetna U.S. Healthcare has been paying the Ellwood City Hospital 77.2 cents for every dollar of cost.

"How can any business, including a hospital, stay in business indefinitely when it's forced to provide a dollar's worth of service for 77.2 cents?" he said.

Response: Aetna U.S. Healthcare spokesman Walter Cherniak said his company hasn't given up hope that an agreement will be made with the Ellwood City Hospital.

"We are in negotiations and we will continue to be in negotiations. We would like to be able to keep them in our network," Cherniak said.

"But frankly we cannot agree to pay the rates they want. They are asking for a 101 percent increase in patient services. We have offered to increase our rates, but not that high."

Cherniak said there are 400 people who would have to change doctors if the insurance company and hospital cannot come to an agreement by June. Those affected have Aetna U.S. Healthcare insurance through their employers.

Not Medicare HMO: This insurance differs from the Medicare HMO insurance that Aetna U.S. Healthcare has decided to pull from Lawrence County at the end of this year.

Cherniak said it is premature for people in Ellwood City with their insurance to think about changing hospitals or doctors.

Scuba said he wouldn't rule out more negotiations, but the hospital's problems with Aetna U.S. Healthcare go beyond disagreements over fees.

"There are times that they give authorization for longer stays than they originally authorized on the first day. Two months later when it's time to pay, they short us those extra days by saying they shouldn't have authorized it in the first place," he said.

Scuba said other insurers have done the same thing, but it happens most frequently with Aetna U.S. Healthcare.

Officials from Lawrence County's two other hospitals, Jameson and St. Francis, said they still have contracts with Aetna U.S. Healthcare and there are no plans to drop it.




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