Aetna network, Cornell psychiatrists expand reach of health plan

by ZACH VEILLEUX

Several improvements to the university’s self-insured health plan and flexible spending accounts, which the university’s Human Resources Office says will enhance the plans, reduce costs to the university and to plan participants and help eliminate some paperwork, have been implemented this fall.

The most sweeping change is to the network of doctors and medical facilities to which participants in The Rockefeller University’s Group Health Care Expense Plan — often referred to as “Principal” after the company that administers it — have access for in-network benefits that do not require fulfilling a deductible and paying coinsurance. (Thirty-nine percent of those who receive health coverage from the university use the Rockefeller plan; the change does not apply to those who have Oxford.)

Even though the Rockefeller plan has both in-network and out-of-network benefits, participants in the plan save money when they use in-network doctors. These doctors have agreed to charge lower, prenegotiated prices for their services. While the university benefits from those discounts, plan participants also pay less, since they are responsible only for a flat copayment per visit. Since January 1, 2005, the Rockefeller University plan has used the PHCS (Private Healthcare Systems, now part of MultiPlan) network, which consists of approximately 450,000 health care providers and 4,000 medical facilities such as hospitals and clinics nationwide.

Effective November 1, the university replaced PHCS with the Aetna Signature Administrators (ASA) network, which consists of approximately 939,000 health care providers and more than 5,000 facilities nationwide. The larger network means that people will have more doctors and hospitals from which to choose without having to pay their yearly deductible. Because Aetna has been able to negotiate more favorable rates with doctors, the switch is also projected to save the university as much as $1.5 million in benefit claim costs.

“This is really a win-win situation,” says Virginia Huffman, vice president for human resources. “We’re getting a broader network and we’re reducing our costs.”

Though the possibility of switching networks has been under consideration by Human Resources since moving to Principal in January 2008, before pulling the trigger Ms. Huffman wanted to ensure that the disruption to members of the health care plan would be minimized. “To measure the projected impact, we ran a simulation in which 12 months of real claims were put through the system as though they would be paid using Aetna’s network,” Ms. Huffman explains. “We found that the disruption was minimal, as the vast majority of PHCS doctors that our members were seeing also belong to Aetna.”

In a second expansion to the plan, the university has also added a small but specialized group of doctors to the Weill Cornell network, which members of the Rockefeller plan can see for a flat $10 copay. Announced in October, but retroactive to July 1, visits to any of the participating doctors in the department of psychiatry of the Weill Cornell Physicians Organization (WCPO) will be covered as an in-network benefit. Although most WCPO visits have been counted as in-network since 2007, mental health visits to WCPO psychiatrists had previously not been included.

“We’re very pleased that we’ve been able to offer access to these services,” says Ms. Huffman. “It can be difficult to find psychiatrists in New York City that accept insurance plans at all, and this arrangement will allow members of the Rockefeller community to seek mental health care at an affordable cost and without having to pay up front and then submit claims for reimbursement.”

Although Ms. Huffman reports that the transition to the Aetna network and the WCPO psychiatry practice have mostly gone smoothly, there are likely to be a few bumps in coming months, particularly as doctors begin to file claims using the new networks. “We encourage people to call Principal or our benefits office if they are having problems,” Ms. Huffman says.

Finally, members of the community who take advantage of the university’s flexible spending accounts for health care expenses — a way to set aside money for certain out-of-pocket health care expenses before it is taxed — now have the option of charging eligible expenses to a special debit card rather than submitting receipts and waiting for reimbursement from Principal.

“This is going to be a great convenience for many people, and it will save a lot of paperwork,” says Doreen Look, senior benefits administrator.

Debit cards will be distributed by early January to those who have elected to participate in the program.