Nashville doctors wield clout over Aetna

Pediatricians' insistence that they need continued access to a local medical center prompts the insurer to make an unusual coverage arrangement.

By Leigh Page, AMNews staff. May 7, 2001.

When Vanderbilt University Medical Center in Nashville, Tenn., terminated its contract with Aetna U.S. Healthcare March 1, it gave local pediatricians the chance to show Aetna that it needed them as much as they might need the insurer.

Aetna agreed to let pediatricians -- and pediatricians only -- continue referring patients to Vanderbilt at full in-network charges.

The pediatricians had decided that without access to Vanderbilt, the only children's hospital in Nashville, and its 150 pediatric subspecialists, they would have to terminate their own Aetna contracts.

After years of enduring low payments and unbending policies at Aetna, pediatricians discovered that "they needed us," said Joseph Lentz, MD, part of a seven-member group in Nashville and president of the Tennessee Pediatric Society.

All other insurers in Nashville still allow full access to Vanderbilt. Without pediatricians, Aetna would have had an incomplete network of little value to local employers, Dr. Lentz said. "The first thing families look for is their pediatrician on the list."

In the negotiations, Aetna rejected Vanderbilt's demand for a payment increase, and negotiations ceased weeks before the contract deadline. The company said the termination means 6,000 nonpediatric members would have to change hospitals or receive significantly reduced coverage at Vanderbilt.

Addressing the pediatric arrangement, Aetna spokeswoman Wendy Morphew insisted that it was standard policy for Aetna to grant full coverage for services that cannot be found within its network. [...]