Aetna/Montefiore Resolve New Contract

Dear SWSCHP Member,

I write to you today with an important message about how SWSCHP is working to help ALL MEMBERS navigate the uncertainties of health care services today.

In early September, Aetna and the Montefiore Health System agreed upon a new contract. In the weeks prior to this agreement, many of our retired members, who receive their health services through the Aetna Medicare Advantage plan, became concerned that they would no longer have access to their doctors and the hospitals within the Montefiore system, or that they would be responsible for costs that were otherwise paid by their plan. That concern was elevated by hospitals in the network who sent out “warning” letters, and and unclear communication from Aetna.

The services for our retired members were never in danger of being lost or financially compromised. Under the terms of our plan, all doctors and hospitals would have still been available, and all normal coverages would have applied. SWSCHP would not allow our members to be abandoned!

This incident points to a larger concern: Can we always trust that everything will remain the same in terms of our expectations for health care services? In fact, even though this case only raised concern for our retired members, related issues could always arise in the future that affect ALL members of SWSCHP.

The dispute that took place between Aetna and Montefiore is all too common. It’s similar to the disputes between large cable television distributors and content providers, as consumers are held hostage while corporate contractual disputes are resolved. In addition, there are a host of factors that have created upheaval in the health care world: large corporate mergers, network provider consolidation, the broad implications of technology, political upheaval, and, of course, the “squeeze” that insurers put on the insured.

The executive board and I are keenly aware of how these developments potentially imperil your expectations for high-quality health care. Remember, our job is to serve our members by providing quality health care benefits in the most effective, competitive and fiscally responsible manner. So how do we accomplish this?

SWSCP – our Executive Board – has ultimate responsibility for hiring good partners who, in turn, negotiate directly with health insurers, on behalf of our members. We empower these partners – companies like Alicare and Wright Risk Management – to meet our mission and work in your interest. But change – even with SWSCHP by your side – is inevitable. If, for example a five-year agreement with a prescription drug provider can be replaced with a different company that is deemed better for our members, we will be obligated to carefully consider it. If a health insurance provider is not living up to its obligations, we will doggedly pursue a relationship that does right for SWSCHP members.

We will always realize outcomes that are consistent with our mission and put our members ahead of every decision. There will be changes within our control, and changes that are out of our control. But make no mistake: Wherever and whenever needed, SWSCHP will work to ease the uncertainties and impacts of a restless market.

Sincerely,

Dr. Peter Mustich, Executive Director