Aetna, Family Practice Associates reach agreement

Aetna logo
Aetna logo

Aetna and Family Practice Associates of Lexington have come to an agreement that will allow about 1,000 patients to stay with the Lexington practice.

Meanwhile, Aetna announced that it will cease offering insurance in the Obamacare health exchanges in 11 states, including Kentucky, in 2017.

Family Practice Associates sent letters in June to patients identified as Aetna participants telling them that as of Aug. 31, the practice would no longer accept Aetna. FPA serves more than 50,000 patients.

Patients carrying Medicare Advantage and Medicare HMO would both have been affected. Those who have traditional Medicare as their primary coverage but have Aetna supplementary insurance would have still been able to use FPA.

With the Aetna-FPA resolution, all of those patients will be able to use FPA. Craig Gillispie, FPA’s administrator, said he signed the final agreement with Aetna last week.

FPA will be notifying patients that they do not need to change physicians, Gillispie said.

Without FPA, Aetna patients in Lexington would have had only a handful of general practice and family physicians available.

Aetna is in the midst of a proposed merger with Humana. But the Justice Department in July filed lawsuits to block that deal, as well as the merger between Anthem and Cigna, citing concerns about having the nation’s health care in the hands of three mammoth companies.

Those companies would be Aetna/Humana, Anthem/Cigna and UnitedHealth Group, which is the nation’s largest insurer.

Aetna said Tuesday that it will stop offering health care insurance options through the Affordable Care Act exchanges in 68.9 percent of the counties where it offered plans in 2016. Aetna will only offer certain plans in Delaware, Iowa, Nebraska and Virginia, down from 15 states.

Kentucky is among the states affected, along with Arizona, Florida, Georgia, Illinois, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina and Texas.

“Providing affordable, high-quality health care options to consumers is not possible without a balanced risk pool,” Aetna chairman and CEO Mark Bertolini said in a statement. “Fifty-five percent of our individual on-exchange membership is new in 2016, and in the second quarter we saw individuals in need of high-cost care represent an even larger share of our on-exchange population.”

Those affected keep their Aetna plans through the end of 2016, but will have to switch plans for 2017.

Cheryl Truman: 859-231-3202, @CherylTruman