A patient’s holiday wish for Aetna/Trinity Health contract resolution

If prior experience has taught Carol Roby anything, it’s that a relationship built on trust can withstand nearly any challenge. A partnership with healthcare providers is no different.

Roby, of Feasterville, is a self-described “65-year-old woman who is still employed.” While many people begin the retirement process at age 65, some are not yet ready—or simply cannot afford—to leave the workplace. Roby’s plan was to stay in the workforce until she reached 67 years old.

“My employer provides health insurance,” she says, “so I have not signed up for Medicare—other than Part A. [My employer] offers an Aetna Point of Service plan that covers the majority of each employee’s premium for the month; as they feel responsible to keep their employees healthy. The percentage of the premium changes as the tier level changes (employee/spouse, family, etc.), but in my case, as a single, my company covers approximately 85 percent of the premium. I was planning on keeping this coverage as long as I am still employed, which is about two more years.”

This plan recently fell in jeopardy when Roby received a letter from her insurer. “I was notified by Aetna that my primary care physician, Meridith Ray, ‘is leaving your plan’s network as of 01-01-2025’,” she explains. “I then found out about the dispute between Trinity Health and Aetna.”

Trinity Health Mid-Atlantic is part of Trinity Health—one of the largest multi-institutional Catholic healthcare delivery systems in the nation, serving diverse communities. The two organizations have been negotiating a new contract since early 2024.

Roby has established relationships with doctors on the medical staff of St. Mary Medical Center, where she also goes for most of her testing procedures. As an older adult, she is uncomfortable with changing doctors at this stage of life. “While a younger woman, I went through primary care provider changes for various reasons,” she says. “One doctor stopped taking insurance claims and became a concierge doctor that I could not afford. Several others have retired, moved out of the area or just left their practices.”

As the holiday season is upon us, Roby has one sincere wish: “For Aetna and Trinity Health to settle their dispute so that I do not need to make any changes.”

Roby’s experiences are not uncommon. Finding new doctors can take a long time, and the process to build trust and a rapport with them takes even longer. If given the choice, most patients would rather not go through that process.

“If Aetna and Trinity Health do not settle their dispute, I have three poor options,” Roby says. “They are:

1. Leave my employer’s group plan and join Medicare with a supplement at a great cost to me to keep my current doctors.
2. Keep my employer’s group plan and change all of my doctors who are associated with Trinity Health.
3. Keep my employer’s group plan and use Trinity Health providers as “out of network” coverage.

None of these options are appealing to me and will cost me dearly in one way or another.”

As the holiday season is upon us, Roby has one sincere wish: “For Aetna and Trinity Health to settle their dispute so that I do not need to make any changes.”

Most commercial insurance plans will renew on January 1, 2025, so time is running short. Our patients are feeling pressured to make decisions they may not have intended to address. Trinity Health continues to advocate for its patients and put their health before profit.