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Insurer and doctors group reach agreement

Kettering Physician Network and Aetna reach terms for reimbursement fees.

Giant health insurer Aetna said Thursday it has reached an agreement to continue covering patients of the 300 area doctors in the Kettering Physician Network.

“This contract should be all set,” Aetna spokeswoman Cynthia Michener said. “We’ve reached an agreement and should finalize it today or tomorrow. Insurers and providers negotiate contract renewals all the time and generally come to favorable resolution.”

Kettering spokeswoman Elizabeth Long said Aetna “did contact us today, and we’re still in negotiations. Nothing has been signed by either party. We’re very hopeful. Obviously, we’d like this to be resolved.”

Terms of the contract proposal weren’t released, but a new contract would remain in effect for at least two years, Michener said. The existing contract ends Nov. 30.

Last week, KPN’s chief medical officer, Dr. David Doucette, sent a letter to the group’s Aetna patients, warning that KPN doctors would be considered out-of-network under Aetna plans beginning Dec. 1, if Aetna and the group could not agree to terms for a new contract. That would mean Aetna patients would either have to find new doctors or pay more medical costs out of pocket if they stuck with KPN.

“We find ourselves in this situation very reluctantly,” Doucette wrote in the Sept. 25 letter. “Kettering Physician Network will continue to advocate for our patients so they have access to affordable, quality health care. Our request of Aetna is to be reimbursed fairly for services delivered to our patients. We hope to reach an agreement in the near future.”

Kettering Physician Network consists of about 300 doctors at 70 locations in the Dayton and Cincinnati areas, Long said. She said she could not say how many patients may be affected.

Aetna reached a contract impasse last fall with PriMed Physicians, forcing about 4,800 patients to find new doctors or pay more out-of-pocket costs. “On PriMed, there have been no recent discussions, but we’d be more than happy to work on a new contract with them,” Michener said. “We frequently evaluate the ever-changing market dynamics for opportunities at competitive rates.”

Aetna has about 46,000 members in the Dayton region.

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