Important information for patients with Aetna health insurance
We continue to negotiate for a fair agreement but remain far apart with Aetna. Despite our best efforts, Aetna has continued to delay progress and has yet to offer a proposal that meets the needs of St. Mary’s. If we cannot reach an agreement before January 1, 2025, Aetna may force St. Mary’s Health Care System’s facilities and doctors out-of-network.
Aetna’s current reimbursement does not adequately cover the true cost of care we provide. Yet, Aetna keeps raising premiums and out-of-pocket costs for its members, to boost their profits, which topped $5.6 billion in 2023. We are asking Aetna to put patient health over their wealth. For us, Health Comes First.
We are asking Aetna to do its part to protect the care our patients, Aetna members, deserve. St. Mary’s is committed to providing high-quality patient care, which depends on fair payment from insurers.
Let Aetna know that your health should come first—not their profits. We're working tirelessly to reach an agreement, but we need Aetna to step up and put patients first.
We believe Health Comes First
We know how important it is for you and your family to receive care from the trusted doctors, nurses and staff at St. Mary’s. As a not-for-profit, 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. We are asking health insurers to put patients first just like we do. Without them doing their part, access to care is at risk. St. Mary’s provides high-quality care in our community while doing our part to make health care affordable – in 2023 alone, we've invested more than $9.5 million in community benefits. Unfortunately, Aetna keeps raising premiums and out-of-pocket costs for its members to boost their profits, which topped $5.6 billion in 2023. We are asking Aetna to put patient health over their wealth. For us, Health Comes First.
Frequently Asked Questions
You deserve access to high-quality health care
At St. Mary’s, we believe our community members deserve options for high-quality care, and we are proud to be one of Georgia’s most trusted health care providers. That’s why we’re working to protect our ability to serve patients for generations because health comes first.
If you do not find the answers to your negotiation-related questions on this site, please contact us directly via this website through our Contact Us page or call our patient line at (706) 381-0005. This website will be updated as our negotiations continue, so please check back for the most up-to-date information.
Q: I have an Aetna health plan. What does this mean for me?
For now, nothing changes. You should continue to visit St. Mary’s 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. Mary’s will be forced out of network and patients may have to pay more when seeking care with our hospital, clinics and employed providers.
Q: What is happening?
St. Mary’s 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.
Q: Why is this happening?
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.
Q: When does the contract with Aetna end?
Our current agreements will expire effective January 1, 2025.
Q: Which Aetna health plans are affected by the negotiations?
All Aetna commercial and Medicare Advantage products.
Q: Which providers and facilities are impacted?
All St. Mary’s facilities and employed providers are impacted by these contract negotiations.
What can I do to protect my in-network access to St. Mary’s?
While our negotiations with Aetna continue, you can take these steps to protect your access to in-network care with St. Mary’s:
- 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. You can contact MedicareCompareUSA licensed Medicare advisors at MedicareOnDemand.com or call our Medicare insurance helpline toll-free at (855) 562-7230 to review what options include St. Mary’s providers. We work with many health plans that will give you in-network access to St. Mary’s for the 2025 benefit year. To view the complete list of insurance plans we accept, visit https://www.stmaryshealthcaresystem.org/for-patients/billing-insurance/accepted-insurance. Please note that we are also in negotiations with Humana.
- 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. Mary’s.
- If you receive insurance through your employer, ask about health plans that include St. Mary’s. Your employer may be able to provide you with secondary health plan coverage that includes access to your trusted caregivers.
- 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. Mary’s.
Q: What if I’m in the hospital when the contract ends?
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.
What if I have an elective procedure scheduled at a St. Mary’s facility on or after January 1, 2025?
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. Mary’s if Aetna forces us out of its provider network.
Q: What if I have an emergency on or after January 1, 2025, and St. Mary’s is out of network?
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.
Q: How can I stay up to date on the negotiations?
For the most up-to-date information, we encourage you to contact us by visiting www.stmarys-health.org/aetna or calling our patient hotline at (706) 381-0005.
What You Can Do
There are ways to protect your ability to affordably access St. Mary’s in 2025, regardless of our status with Aetna. Consider the following:
- 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. You can contact MedicareCompareUSA licensed Medicare advisors at MedicareOnDemand.com or call our Medicare insurance helpline toll-free at (855) 562-7230 to review what options include St. Mary’s providers. We work with many health plans that will give you in-network access to St. Mary’s for the 2025 benefit year. To view the complete list of insurance plans we accept, visit https://www.stmaryshealthcaresystem.org/for-patients/billing-insurance/accepted-insurance. Please note that we are also in negotiations with Humana.
- 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 undergoing 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. Mary’s.
- If you receive insurance through your employer, ask about health plans that include St. Mary’s. Your employer may be able to provide you with secondary health plan coverage that includes access to your trusted caregivers.
- 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. Mary’s.