A public breakdown in negotiations between Central Kentucky's dominant physician's group and health insurance provider Aetna could impact thousands of patients in coming months.
In a Sunday newspaper ad, Lexington Clinic announced that it will not renew a contract with Aetna, which means the insurance company would stop covering visits to the clinic's 150-plus physicians.
The ad said Aetna patients will be cut off from Lexington Clinic services effective Feb. 1, 2010, for ambulatory surgery and June 1, 2010, for physician services.
Aetna has 20,000 customers in 11 Central Kentucky counties. Employees of the Herald-Leader are among its 10,967 customers in Fayette County. Lexington Clinic is a multi-specialty practice with more than 20 Central Kentucky locations, 1,000 full-time employees and more than 5,000 patient visits daily.
Lexington Clinic administrators did not respond to repeated requests for comment.
Scott Roskelley, a Chicago-based spokesman for Aetna, said in a statement: "At issue with Lexington Clinic are negotiated rates between Aetna and the Clinic's ambulatory surgery center. While we would prefer to have Lexington Clinic in our network, we have a network of hospitals and physicians in Lexington that can meet our members' health care needs."
Roskelley's statement said that Aetna will assist customers with transition of their care "with minimal disruption" and that 1,600 physicians, 800 additional health care providers and 18 hospitals will be available to Aetna patients in the 11-county Lexington area.
Kentucky Department of Insurance spokeswoman Ronda Sloan said that the department was not notified of Lexington Clinic's action.
The Lexington Clinic announcement said the clinic had informed Aetna twice — on Sept. 14 and Nov. 30 — that it will not renew its agreement with the company.
Sloan said there is no requirement that health care providers notify the state when they terminate agreements with insurance companies.
Patients calling the contact number provided by the clinic — the clinic's marketing department at (859) 258-6116 — were referred to Aetna.
Sloan said that Kentucky law requires a health insurance plan to notify consumers when a primary care physician is terminated from the plan and arrange for continuity of care.
Sloan said that patients with complaints may contact the insurance department at 800-595-6053.