ZANESVILLE, Ohio — Genesis HealthCare System has reached new agreements with CareSource and Aetna that will keep many Muskingum County patients in-network through 2027, according to a release from Genesis reported by the Zanesville Times Recorder on Oct. 29. CareSource Medicaid, the Next Generation MyCare Ohio Plan and Aetna Medicare Advantage members will maintain in-network access to Genesis under the new deals, the Times Recorder reported.
The agreements end, for those plans, a standoff that had put coverage in doubt for the new year. Genesis had previously said it would end contracts on Jan. 1 for Medicare Advantage plans under Aetna, UnitedHealthcare and Medical Mutual of Ohio and for Medicare Advantage and Medicaid plans under CareSource unless new agreements were reached, according to the Zanesville Times Recorder.
The dispute grew out of denied and disputed claims. The agreements come nearly two months after Genesis announced that 9,000 denied and disputed claims from four providers and millions of dollars in losses had weighed on future contracts, the Zanesville Times Recorder reported. Genesis said last month that it does not send surprise bills to patients for amounts it believes insurers should cover, leaving the health system to absorb unpaid costs, according to the Times Recorder.
That financial pressure matters beyond Zanesville because Genesis said absorbing those costs affects its ability to maintain staff and provide local health services, the Zanesville Times Recorder reported. For patients in Muskingum County and surrounding southeast Ohio communities, keeping a local system in-network can mean keeping scheduled care, specialists and hospital services closer to home instead of facing out-of-network costs or longer travel.
Two sets of negotiations are not finished. Genesis anticipates releasing another announcement on the other insurance plans in the near future, according to the Zanesville Times Recorder. Existing coverage for the remaining plans will remain unaffected through Dec. 31, and if no agreements are reached, those plans would become out-of-network for nonemergency care at Genesis on Jan. 1, the Times Recorder reported.
Emergency care is treated differently. Emergency care will remain covered at in-network rates regardless of contract status, Genesis previously said, according to the Zanesville Times Recorder. Commercial employer-sponsored health insurance plans and traditional Medicare supplement, or Medigap, plans are not affected by the contract dispute, the Times Recorder reported.
Genesis has advised patients to keep scheduled appointments, continue seeking medical care and use the emergency department when needed, according to the Zanesville Times Recorder. Patients seeking updates on insurance coverage can check the Genesis website or call the Patient Financial Advocate Hotline at 740-454-4335, the Times Recorder reported. Members of the remaining plans should watch for Genesis’s promised follow-up announcement before the Dec. 31 deadline.
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