Ethan Rhodes
Aetna is a CVS Health company that offers its members access to a wide range of healthcare providers, including doctors, specialists, dentists, hospitals, and surgical centers. Members benefit from lower rates and more coverage when they seek care from in-network providers. St. Joseph's Health Syracuse, New York, for example, is an in-network hospital for Aetna members, as is the University of Utah Health.
| Characteristics | Values |
|---|---|
| Aetna in-network with University Hospitals | Yes, for the University of Utah Health hospitals, community health centers, and the University of Utah Health Medical Group |
| St. Joseph's Health Syracuse, New York (NY) Hospitals in-network with Aetna | Yes |
| Out-of-network care with Aetna | Possible, but usually more expensive |
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What You'll Learn
St. Joseph's Health Syracuse, New York (NY) Hospitals
St. Joseph's Health and Aetna have had a somewhat tumultuous relationship, with ongoing contract disputes and negotiations. As of January 1, 2025, St. Joseph's Health and Aetna reached an 11th-hour multi-year agreement, preserving in-network coverage for thousands of Central New Yorkers with Aetna health insurance. This agreement ensures continued access to St. Joseph's Health hospital, facilities, and healthcare providers.
Prior to this agreement, there was uncertainty about whether a deal would be reached, with both parties stating that they were “far apart” in their negotiations. The main issue appeared to be related to reimbursement rates and the cost of services, with St. Joseph's Health seeking higher insurance reimbursements to offset a yearly budget gap. If no agreement had been reached, St. Joseph's Health may have been removed from Aetna's network, resulting in higher costs for patients or the need to find new providers.
It is worth noting that St. Joseph's Health also has similar contract disputes with other insurance providers, such as Humana and Excellus BlueCross BlueShield. These disputes have resulted in St. Joseph's Health being out-of-network with Humana patients, while negotiations with Excellus BlueCross BlueShield have experienced challenges similar to those with Aetna.
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University of Utah Health Hospitals
The University of Utah Health Hospitals is committed to providing high-quality, affordable care to its patients. In line with this, they have established themselves as an in-network provider for several insurance plans, including Aetna.
Aetna®, a CVS Health company, and the University of Utah Health recently announced a new multi-year agreement that will maintain the university's health services as an in-network provider for Aetna members. This agreement covers all University of Utah Health hospitals, community health centers, and the University of Utah Health Medical Group. This partnership ensures that Aetna members can access the comprehensive healthcare services offered by the University of Utah Health system, which includes specialty and primary care.
The University of Utah Health has also developed a tool to assist patients in understanding their out-of-pocket expenses. This tool allows individuals to compare and calculate their expected financial responsibility for healthcare services and procedures, promoting transparency and informed decision-making.
In addition to Aetna, the University of Utah Health Hospitals is in-network with other insurance plans, such as United HealthCare Options PPO, Humana, and Medicare. They also accept out-of-state Blue Cross Blue Shield plans that use the BlueCard network. However, it is important for patients with Blue Cross Blue Shield insurance to verify their coverage, as plans obtained through the ACA/Insurance Marketplace are not considered in-network with the University of Utah Health.
The University of Utah Health Hospitals aims to make healthcare accessible and affordable for its patients by being part of various insurance networks. Patients can utilize their online resources, such as the cost estimation tool, to make informed decisions about their healthcare choices.
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In-network and out-of-network care
If a healthcare provider is in-network, they have a contract with your insurance company, which sets the costs associated with their medical services. This means that the provider has agreed to accept a discounted rate for covered services under your health plan, and you will pay less out of pocket. The insurance company and healthcare provider agree on certain rates, so you will pay a pre-negotiated rate, and the provider cannot charge you more than this.
Out-of-network care refers to healthcare providers who do not have a contract with your insurance company. This means there are no agreed-upon prices for medical services, and you may be charged the full price for visits and services. An out-of-network provider can bill you for anything over the amount that your insurance company recognises or allows, which is called "balance billing". This can result in unexpected medical bills and higher out-of-pocket costs.
It is important to understand the differences between in-network and out-of-network care to make informed decisions about your healthcare and avoid unexpected costs. You can use online search tools to find doctors and hospitals that are in-network for your insurance plan.
Aetna is one of the largest nationwide networks of healthcare providers in the US, including doctors, hospitals, and walk-in clinics. They have a network of University Hospitals, which can be found by logging in and searching for providers that accept your plan.
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Multi-year agreements
Aetna has established multi-year agreements with several hospitals and healthcare providers across the United States, ensuring that its members have in-network access to quality healthcare services. These agreements are significant as they allow Aetna members to receive covered healthcare services at contracted rates, which are typically lower than out-of-network rates.
One notable example is the agreement between Aetna and St. Joseph's Health in Syracuse, New York. St. Joseph's Health and Aetna reached a multi-year agreement to maintain in-network access for Aetna members to their hospital, facilities, and healthcare providers. This agreement ensures that patients can continue to receive care at St. Joseph's Health without disruption and at the contracted rates agreed upon between Aetna and the healthcare provider.
Similarly, the University of Utah Health and Aetna also announced a multi-year agreement, keeping the University of Utah Health as an in-network provider for Aetna members. This agreement encompasses all University of Utah Health hospitals, community health centers, and the University of Utah Health Medical Group. The collaboration between the two organizations ensures that Aetna members in Utah can access high-quality, affordable care within the University of Utah Health system.
These multi-year agreements between Aetna and healthcare providers, such as St. Joseph's Health and the University of Utah Health, demonstrate a mutual commitment to delivering convenient and cost-effective healthcare services to Aetna members. By maintaining in-network status, patients can benefit from lower out-of-pocket expenses and streamlined access to a wide range of healthcare options.
It's important to note that the specific terms and conditions of these multi-year agreements may vary, and members should refer to their individual Aetna health plans for detailed information about covered benefits, in-network providers, and any applicable deductibles or coinsurance. Nonetheless, these agreements play a crucial role in shaping the healthcare experience of Aetna members, providing them with a sense of assurance and access to a comprehensive network of healthcare providers.
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Aetna Smart Compare®
When searching for a doctor on the Aetna Health℠ app or the Aetna member website, members can look for the "Quality and Effective Care" label, which indicates that the physician has received the Aetna Smart Compare® designation. This designation serves as a guide to help members choose a physician that suits their needs, providing transparency and assurance of the doctor's quality.
The Aetna Smart Compare® designation is based on a thorough evaluation of multiple data points, including health information, claims data, and results. Physicians are assessed for their clinical quality first and then reviewed for cost-effectiveness. This two-step process ensures that members can easily identify doctors who deliver exceptional care while also considering cost efficiency.
It is important to note that the Aetna Smart Compare® designation does not impact a member's plan or reimbursement rates. It is solely a tool to empower members to make informed choices about their healthcare providers. Members can utilize the search tools on the Aetna platform to find doctors, hospitals, and providers that accept their insurance plan, with or without the Aetna Smart Compare® designation.
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Frequently asked questions
Yes, Aetna has a multi-year agreement with the University of Utah Health hospitals, community health centers, and the University of Utah Health Medical Group.
A network is a group of healthcare providers, including doctors, specialists, dentists, hospitals, and surgical centers, that have a contract with Aetna. This contract allows them to provide services to members at a discounted rate.
If you go out of network, your out-of-pocket costs are usually higher. Your Aetna plan may pay part of the bill, but it will be less than if you received care from an in-network provider. Additionally, some plans do not offer any out-of-network benefits, so you would have to pay the full cost unless it is an emergency.
