Aetna's fee fight adds to cancer patient's stress

Staff WriterMarch 5, 2011 

The last thing Jean Holstein needed as she faced eye surgery and ongoing chemotherapy for breast cancer was a battle with her insurance company.

But Holstein, along with thousands of others in the Triangle and beyond, was covered by Aetna, which UNC Health Care and its physicians stopped accepting last month because of a fee dispute.

Hurt most are patients like Holstein who have long-term needs for cancer, transplants and other complicated care. This group - an estimated 200 patients at UNC Hospitals in Chapel Hill and Rex Healthcare in Raleigh, which is owned by UNC - has been scrambling to get temporary reprieves to keep from switching their care.

But if the hospital and insurer don't resolve their differences, even these long-term patients are faced with finding new treatment teams at hospitals where Aetna still is accepted, or paying higher out-of-pocket expenses to stay in the UNC fold.

"People talk about the free market taking care of things, well, this is the free market," said Holstein, 54, who drives from her home in Jacksonville to see her doctors in Chapel Hill.

She said she is ticked off at the insurance company, which posted a 34 percent rise in earnings last year, reaping $1.6 billion. The company credited its fortunes to "management actions to appropriately price the business."

Aetna cites costs

Walt Cherniak, a spokesman for Aetna, said the company is duty-bound to hold down costs, and could not meet UNC Health Care's demand for a double-digit increase in the rates the insurer pays on behalf of its customers.

"As a health insurer, we have dual obligations," Cherniak said. "One is to provide broad access to quality hospitals and doctors for our customers. We also have an obligation to try to contain rising health care costs, which have been a major problem to employers and patients."

Cherniak said the money to pay UNC Hospitals, Rex and their affiliated doctors comes directly from the businesses that have signed up with Aetna to manage their health plans. As a result, Cherniak said, an increase in hospital and doctor fees "directly hits consumers of the Raleigh-Durham area in the pocketbook."

Holstein isn't convinced. In an open letter to Ronald A. Williams, chairman of Aetna, she calculated the cost of her care over the next 12 years as a fraction of his pay, which Forbes tabbed at $7.3 million last year.

"Yet it would destroy all our carefully put away retirement savings," she wrote.

Aetna grants reprieve

In an interview, Holstein said she was able to get a short reprieve for some of her care, with Aetna agreeing to pay UNC Hospitals and her doctors for the eye surgery she had this past week, plus the chemotherapy she needs monthly.

The stopgap coverage will continue only until May, however, when she'll be required to find other solutions if Aetna and UNC Health Care don't come to terms.

Karen McCall, a spokeswoman for the hospital system, said talks are continuing, but the impasse has not been broken.

"Nobody's changed their position," McCall said.

There is precedence for the stalemate to be resolved. Aetna agreed to a new deal with a Winston-Salem hospital chain last summer after a three-month battle, and UnitedHealthcare signed a new contract with WakeMed more than four months after dropping the hospital from its network four years ago.

For Holstein, the ordeal of haggling with the insurer in the days leading up to her surgery took a toll.

"I was so angry dealing with insurance," she said. "There were other things I wanted to be doing, and I spent all my time worrying about that. It's infuriating. They're playing with people - playing with people's lives and money."

sarah.avery@newsobserver.com or 919-829-4882

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