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Network: Lodi Hospital Pending Termination Extended to October 2013
Jul 31, 2013
Aetna's negotiations with Lodi Memorial Hospital are still in progress. The pending termination date has been extended to October 1, 2013 from August 1, 2013.
- Aetna issued a termination to Lodi Memorial Hospital with the intent to renegotiate the contract. Lodi Primary Care is also part of this renegotiation.
- It is Aetna’s objective to maintain competitive contracts that are reasonable to their customers, members and the hospital.
- Aetna is willing to continue its contractual relationship with Lodi Memorial to the extent that the terms and structure of the contract meet the needs of their constituents.
There are 14 participating physicians who have exclusive admitting privileges to Lodi Memorial Hospital. This includes 9 primary care physicians (PCPs) and 5 specialists.
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.
525 West Acacia Street
Stockton, CA 95203
Doctors Hospital of Manteca
1205 East N Street
Manteca, CA 95336
Doctors Medical Center
1441 Florida Avenue
Modesto, CA 95350
Emanuel Medical Center
825 Delbon Avenue
Turlock, CA 95382
Memorial Medical Center
1700 Coffee Road
Modesto, CA 95355
St. Joseph's Medical Center
1800 North California Street
Stockton, CA 95204
Aetna will send letters to the following employees and their dependents:
Aetna will help with transition of care
- Employees and their dependents who have been treated by a Primary Care Physician at least once in the past 12 months.
- Employees and their dependents who have selected a Primary Care Physician.
- Employees and their dependents who have been treated by a specialist provider at least twice in the past 12 months.
- HMO based products: Employees and their dependents who have utilized the terminating hospital at least once in the past 12 months.
- Non-HMO based products: Employees and their dependents who have utilized the terminating hospital at least twice in the past 12 months.
- Commercial member letters were mailed on July 15, 2013.
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:
- Acute conditions
- Severe Chronic conditions
- Terminal Illness
- The care of a child ages 0-36 months
- Previously scheduled surgery or other procedures
If any employees 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, their 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.
Lodi Memorial Hospital will be removed from Aetna's DocFind online directory by the termination date. Aetna updates DocFind six days per week with provider information coming directly from Aetna’s Enterprise Provider Database (EPDB). EPDB is the single source of provider data for all U.S.-based providers. Current printed provider directories include Lodi Memorial Hospital. This Hospital will be removed from the next directory edition.
If you have any questions regarding this message, contact your b&p Sales Team - 888.722.3373.