A:        For now, nothing changes. You should continue to visit St. Joseph’s Health facilities and employed physicians as you normally would. If Aetna does not work with us to reach a fair agreement before January 1, 2025, St. Joseph’s Health will be forced out of network and patients may have to pay more when seeking care with our hospital, clinics and employed providers. 

New York law provides continued access to our hospital through February 28, 2025, for fully insured employer sponsored commercial benefit plans. Call Aetna at the number on the back of your insurance card to see if your benefit plan qualifies.

A:        St. Joseph’s Health is negotiating with Aetna for new agreements that appropriately cover the cost of the care we provide patients with Aetna commercial (including employer-sponsored and ACA marketplace) and Medicare Advantage plans. Our current contract will expire January 1, 2025. Negotiations are a routine part of business, and we are doing our best to reach an agreement to minimize impact to patients. What’s not routine is the significant impact inflation has had on our cost to provide the high-quality care you expect, and we need Aetna to do their part to ensure you have access to our care.

A:        As a trusted local care provider, we work tirelessly to care for our patients and communities. We also continue to reduce costs and implement efficiencies to ensure we can continue providing top-quality care to our patients. However, Aetna keeps raising premiums and out-of-pocket costs for its members, like you, to boost their profits, which topped $5.6 billion in 2023. We cannot maintain access to the care and services patients depend on and need without a fair agreement from Aetna. 

A:        Our current agreements will expire effective January 1, 2025. 

A:        The following health plans are impacted:

• Employer Sponsored Commercial

• Medicare Advantage

A:        All St. Joseph’s Health facilities and employed providers are impacted by these contract negotiations.  

A:        While our negotiations with Aetna continue, you can take these steps to protect your
access to in-network care with St. Joseph’s Health:  

• If you are eligible for Medicare Advantage, the Annual Enrollment Period ends on December 7th and you can continue looking for plans through that time, even if you have already made a selection. We work with many health plans, including: 

  • Trinity Health Plan New York (formerly MediGold; an affiliate of St. Joseph’s Health)

  • Traditional Medicare

  • Fidelis Care

  • MVP Health Plan

  • Nascentia Health

  • United Healthcare

  • WellCare

• Never delay care. You will always have in-network access to our emergency department. Regardless of our network status with Aetna, you should always visit the closest emergency department if you experience a medical emergency.

• If you're pregnant or receiving ongoing treatment, call the number on the back of your Aetna insurance card to receive more information about Continuity of Care—you may be able to continue in-network care at St. Joseph’s Health.

• If you receive insurance through your employer, ask about health plans that include St. Joseph’s Health. Your employer may be able to provide you with secondary health plan coverage that includes access to your trusted caregivers. 

• If you are dually-enrolled - Call 1-800-MEDICARE (1-800-633-4227) to learn about available plans, including those that have continued access to your trusted providers.

• Call the number on the back of your insurance card and express how this negotiation is impacting your access to the providers and services you know and trust at St. Joseph’s Health.

A:        If you are already admitted to the hospital before January 1, 2025, you will be covered at in-network rates through the end of your inpatient stay.  

A:        We understand that some patients may have appointments scheduled on or after January 1, 2025.  If possible, you should call your provider’s office to request that the appointment or procedure be rescheduled in advance of January 1, 2025. If you are unable to reschedule your appointment or choose to keep your appointment, you may have to pay higher out-of-pocket costs for your care with St. Joseph’s Health if Aetna forces us out of its provider network.  

New York law provides continued access to our hospital through February 28, 2025, for fully insured employer sponsored commercial benefit plans. Call Aetna at the number on the back of your insurance card to see if your benefit plan qualifies.

A:        Patients will always have in-network access to our emergency department, regardless of our status with Aetna. If you experience an emergency, you should always visit the nearest emergency room. Patients needing emergency care can receive in-network treatment until the patient is stable.   

A:        For the most up-to-date information, we encourage you to contact us by visiting sjhsyr.org/aetna or calling our patient hotline at (315) 314-2552.