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Network: Aetna's Negotiations with Washington Hospital

Aug 15, 2012

Highlights:
The purpose of this communication is to keep you informed about progress made during Aetna’s negotiations with Washington Hospital. This update, and the ones that follow, will supplement the original network update you received on June 28, 2012. Aetna will keep you informed of updates until all negotiations are complete and/or concluded

Update # 1:

Washington Hospital located in Fremont, CA terminated from Aetna's Northern California Aetna Non-HMO products on August 1, 2012 and may terminate from Aetna's HMO products effective October 1, 2012.

Aetna was unable to reach a new agreement prior to the termination date for the Non-HMO products.  The hospital is no longer participating in Aetna’s network for the Non-HMO products listed below as of August 1, 2012.  Member letters were mailed around August 1, 2012 for those products.

Aetna is still in negotiations with Washington Hospital for the HMO-based products.  If Aetna does not reach an agreement with the hospital for those products, the contract will terminate effective October 1, 2012.  

The contracts with 73 participating physicians who have exclusive admitting privileges to Washington Hospital are scheduled to terminate on October 15, 2012. This includes 34 primary care physicians (PCPs) and 39 specialists. Member letters will mail within 5 days of the provider termination date if Aetna does not reach an agreement.

Hospital Location
Washington Hospital
2000 Mowry Avenue
Fremont, CA  94538

Aetna TERMINATED the Washington Hospital contract for the following Non-HMO products effective August 1, 2012:

The Washington Hospital contract is SCHEDULED TO TERMINATE for the following HMO products on October 1, 2012:

Alternate Hospitals available
Below is a listing of alternate participating hospitals in the immediate area where employees and their dependents can continue to access care. Aetna Performance NetworkSM alternative hospitals are denoted by this blue seal .

Eden Medical Center
20103 Lake Chabot Road
Castro Valley, CA 94546-5305

ValleyCare Health System 
5565 West Las Positas Boulevard
Pleasanton, CA 94588-4001

San Ramon Regional Medical Center
6001 Norris Canyon Road
San Ramon, CA 94583-5400

O’Connor Hospital
2105 Forest Avenue
San Jose, CA 95128-1425

Santa Clara Valley Medical Center
143 North Main Street
Milpitas, CA 95035-4322


Member letters:

Aetna will send letters to the following employees and their dependents:

Aetna will help with transition of care:
For self-insured plans, Aetna’s standard Transition of Care Coverage Policy will apply to members actively in a course of treatment.

For fully-insured plans, as required by law, Aetna’s California addendum to its standard Transition of Care Coverage policy provides for completion of covered services for:

If any employees will require frequent or continuing consultation with a specialist physician for ongoing covered care, the employee should contact his or her current PCP who can help arrange transfer of that care to a similar specialist in the Aetna network. In addition, Aetna wants to help maintain continuity of care coverage if any employees are currently undergoing treatment with a specialist affiliated with the affected facility.  In such an instance, Aetna's National Precertification clinical staff will review these cases and, when necessary, offer assistance to members who require transition of care coverage by directing the member to Aetna Member Services or DocFind.  For a limited time and when appropriate, Aetna will cover certain ongoing medical care for a specified period at the preferred level of benefits, rendered by a specialist who no longer participates in the network.

DocFind/directory information:
Aetna has removed Washington Hospital from their DocFind online directory for the PPO-based products, and will remove the hospital upon the next scheduled update after the termination date for the HMO-based products.  Physicians that have not obtained admitting privileges at another participating hospital on or before the termination date will also be removed from DocFind during the same update cycle.  Current printed provider directories include Washington Hospital. This Hospital will be removed from the next directory edition. DocFind is updated nightly, and is the most current source of participating physician and hospital information.

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