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02/07/2013

Cook Children's, Aetna insurance meet to discuss contract

Aetna insurance plans to submit a new contract proposal next week to Cook Children’s Health Care System as the two parties seek to end a three-month dispute affecting thousands of Medicaid beneficiaries. The move follows a meeting Thursday that was attended by a representative from the Texas Health and Human Services Commission, who acted as an observer. Cook Children’s, the area’s specialty pediatric hospital, and its affiliated doctors were dropped from Aetna’s managed care network effective Nov. 1, when a four-year contract ended.

Rich Goode, chief financial officer for Cook Children’s, said the hospital hasn’t been willing to sign a new contract because “we feel the services we’re providing and the fees aren’t quite aligned yet.” He said Aetna simply isn’t offering adequate reimbursements to Cook Children’s under a traditional fee-for-service system. “I’m confident we’ll figure something out,” Goode said.

Aetna spokeswoman Anjanette Coplin said that “after the meeting today, we decided to send a counterproposal to Cook’s next week. We are hopeful that the two sides will be able to reach an agreement.”

-- Jim Fuquay

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