CHI Health Partners facilities, physicians and ancillary services (such as laboratory, imaging, surgical services) are now out-of-network for both Commercial and Medicare Advantage patients.
Aetna Commercial plans terminated on November 27, 2024 in Nebraska and Iowa:
- Aetna Commercial HMO-POS-PPO
- First Health Network
Aetna Medicare Advantage plans terminated on October 1, 2024 in Nebraska and Iowa:
- Aetna Medicare HMO-POS
- Aetna Medicare PPO
What is happening between CHI Health Partners and Aetna?
CHI Health Partners has been in active negotiations with Aetna since November 2023. Our goal is to reach an agreement to allow us to continue providing services as an in-network provider to Aetna members at our hospitals and clinics with our affiliated physicians in Nebraska and Iowa. Health care costs have been rapidly rising over the past few years which is why we are working diligently to secure fair reimbursement in our contract with Aetna.
Despite our best efforts, the Aetna NE/IA contract has terminated and CHI Health Partners providers are out-of-network for all Aetna Products. Commercial plans terminated on November 27, 2024 and Medicare Advantage plans terminated on October 1, 2024.
Why is CHI Health Partners working on a new agreement with Aetna?
- CHI Health Partners and other healthcare systems across the United States continue to face substantial challenges due to higher costs for labor, drugs and supplies.
- To ensure our continued success, we regularly renegotiate contracts with health insurance companies every three to four years. This process allows us to adjust rates to account for inflation, ensuring we receive a responsible and fair agreement.
- Fair agreements give us the ability to retain and recruit physicians and other caregivers, to invest in new technology so that patients have high-quality care close to home and serve our communities who depend on us. CHI Health Partners is a non-profit healthcare system dedicated to caring for all in the community regardless of the ability to pay.
- Given our long-standing relationship with Aetna, it is possible that CHI Health Partners and Aetna may reinstate the contracts impacted if a fair agreement is reached. We will keep you informed of any changes in contracting status..
What does this mean for my upcoming procedure/appointment?
Aetna patients who have appointments or procedures currently scheduled, or have been treated over the last several months, may qualify for Continuity or Transition of Care benefits. (See Continuity or Transition of Care section.)
If you’ve been authorized for a procedure that has not yet been scheduled, please call your physician’s office to talk through your options with your clinical team.
What if I have an elective procedure scheduled at a CHI Health Partners facility after the termination date?
We understand that some patients may have procedures scheduled after the termination date. If this is the case, you should call your provider or physician’s office to ensure an authorization is on file for your procedure. You may be eligible for Continuity or Transition of Care (see Continuity or Transition of Care section).
Can I still use CHI Health Partners’ Emergency Rooms if I’m out of network?
Yes. By law, patients always have access to our emergency rooms, regardless of our contract status with Aetna. If you experience an emergency, you should visit the nearest emergency room.
I am a new patient. Can I receive care?
Patients should call Aetna for clarification on which providers are available in their network.
Am I still able to receive care from CHI Health Partners providers and hospitals?
You may still be able to access care from CHI Health Partners facilities, physicians and ancillary services (such as laboratory, imaging, surgical services), but it will likely cost you more. Please contact Aetna regarding your out-of-network benefits and cost. You may still have in-network access to CHI Health Partners services and providers through your Continuity or Transition of Care benefit.
How long could Aetna patients be out-of-network?
Unfortunately, there is no timeline for a successful completion of the negotiation with Aetna. We intend to continue negotiating in good faith for a fair agreement. We will be transparent and keep our community updated throughout the negotiations.
How will Aetna Preferred Provider Plan (PPO) patients be affected if the contract ends?
CHI Health Partners is out-of-network for Aetna Commercial PPO members starting on November 27, 2024.
You most likely will still have access to your CHI Health Partners facilities and physicians, but it may cost you more.
If you are currently receiving treatment for certain conditions you may still be able to access CHI Health Partners services and providers through your Continuity or Transition of Care benefit. This also applies to Point of Service (POS) and Health Maintenance Organization (HMO) patients.
What if I am receiving treatment for a special condition on or after your commercial plan's termination date? (See Continuity or Transition of Care below)
Certain patients, including those who are hospitalized, pregnant or undergoing an active course of treatment, including outpatient oncology infusion services prior to the contract end date, may qualify for Continuity or Transition of Care through Aetna. If you think you may qualify, contact Aetna to complete a Continuity or Transition of Care form.
What if I’m in the hospital when the contract ends on my plan's termination date?
Patients admitted to our hospital before termination will be covered at the in-network benefit level.
What can I do to continue to see my provider?
Medicare Patients
To ensure you can continue to see your trusted CHI Health Partners provider on an in-network basis, consider the following options:
- Contact Aetna at the number on the back of your insurance card. Ask that Aetna work with CHI Health Partners to protect your in-network access to the care you need and deserve.
- Learn more about Traditional Medicare coverage after January 1, 2025: As a patient with Medicare Advantage, you may be able to change your coverage to direct Medicare (Traditional) coverage and purchase a Medigap plan that would cover health care services that are not covered under Traditional Medicare. This may not be an option for all patients, and we suggest you look into this option based on your needs and situation.
- Learn about other Medicare Advantage Plans that include CHI Health Partners providers. Here are the Medicare Advantage Plans which we know will include access to your CHI Health Partners provider network. Medicare’s Annual Enrollment period, which runs from October 15 – December 7, is the time during which you can evaluate which Medicare Advantage plan best meets your needs. Call 855-962-1786 to speak with a Licensed Insurance Agent for more information about the plans.* They can answer your questions and help you understand your choices.
- UnitedHealthcare®
- Blue Cross and Blue Shield of Nebraska
- Humana Medicare
- Medica Medicare
- Wellcare Medicare
Commercial Patients
- Call the number on the back of your insurance card to see what coverage options are available to you.
- Check with your employer to see if there are other Health Plan options that include CHI Health Partners in their network. CHI Health Partners is contracted with most other major insurance plans.
- Talk with your physician if you are in current treatment to discuss whether Continuity or Transition of Care may be available to you.
Continuity or Transition of Care
What is Continuity or Transition of Care and how do I apply?
Certain patients, including those who are hospitalized, or undergoing an active course of treatment prior to the contract expiration date, may qualify for Continuity or Transition of Care services through Aetna.
Continuity or Transition of Care services allows you to continue receiving medically necessary care from CHI Health Partners and our providers at the in-network benefit level for a limited period of time after their termination date.
- If you are in active treatment, you may qualify for protected in-network access through a Continuity or Transition of Care application.
- If you do not complete a Continuity or Transition of Care form before receiving care, you may experience higher out-of-pocket costs.
- For questions about Continuity or Transition of Care eligibility, benefits, and access to the Continuity or Transition of Care form, please call Aetna at the number on the back of your insurance card.
- Note: Once a patient has the Aetna Continuity or Transition of Care form, they will need to consult with their physician to add clinical details and signatures.
Additional Resources
How can I stay up-to-date on the negotiations?
We remain in active negotiations with Aetna, and we are optimistic about reaching a new agreement. As our negotiations with Aetna progress, we will continue to keep our patients informed through regular communication, our patient information line (866) 726-8362 or visit CHIhealthPartners.org/Aetna
Who should I call for questions about billing?
If you have specific questions about billing or Aetna's out-of-network benefits, the best option is to call the Aetna number on the back of your insurance card.
I am employed by Millard Public Schools, One World or Greater Omaha Packing. Does this affect my insurance plan?
Millard Public Schools will remain in network with all CHI Health Partners facilities, physicians and ancillary services (such as laboratory, imaging, surgical services). There are two plans, a broad network or direct (narrow) network.
Our direct contract with Greater Omaha Packing Co, Inc. and One World employees under the CHI Health Partners direct narrow plan are not impacted by this termination. However, their employees accessing Aetna’s broad network may be affected by these contract negotiations, and members should confirm their benefit coverage with Aetna.
As always, please contact Aetna directly using the number on the back of the insurance card to verify if your plan will be affected by this termination.
