Hello -
I have had a lot of questions about the situation with CHI and SLEBC's network, Aetna Open Choice PPO. Because of the influx of calls and emails, I have summarized what I know and options you have if this disruption pertains to you.
1.
Unfortunately, we do not have a date or timeline for the continued negotiations or end date.
2.
While I can usually help expedite the correction of errors, I do not have a magic wand to fix this, as we are a very small group of people that are dealing with this network issue. Many, many employers and Medicare Advantage plan members are also involved.
1.
Options:
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Schedule a visit with an In-Network Provider (possibly for the short-term)
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Pay the higher Out-of-Pocket Costs
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IF you do not have an In-Network Provider within 50-miles of your home address, claims can be processed as In-Network. This is a clause we already have in our Plan Document. If you find this is your situation, please be sure to notify the care coordinators at 866-274-9478.
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Doctor on Demand may be an option depending on the reason for the visit. (When you sign up use SLEBC for the employer.) You can find this information in the attached benefit guide.
Additional Options you may try:
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If you are looking to have a medication refill, you may want to try to message your provider and explain the situation and ask if a refill is possible with the exception that as soon as the contract is negotiated a visit will be scheduled.
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You may reach out to the CHI clinic directly to see if they are willing to negotiate with Aetna. This is unlikely but may be worth asking. If they are willing, they would need to reach out to their Provider Relationship Manager.
The situation is definitely hurting CHI's bottom line, as they are losing revenue by the minute. While this financial pressure is important to the overall negotiations process, it is important for you to know that the SLEBC Board is also monitoring (and personally dealing with) the same situations many of the members are in. It is a bad situation.
We will review the network at our first quarter meeting and discuss possible options. IF we were to change networks, we do not have a guarantee that another network wouldn't have the same issue with their contract negotiation, as BCBS went through this same situation recently with CHI.
At the end of the day, I ask for your patience and understanding that this is not a situation any one of us wants to be in. I will continue to share updates as they are shared with me.
Thank you,
Tara
Tara Johnson
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Subject: Aetna - CHI Health
SLEBC Insured -
I wanted to send a quick note as SLEBC has been notified that CHI has officially opted to not renew their contract with Aetna. This is still an ongoing situation and with many similar situations, we have seen agreements reached after the ‘deadline’.
We will continue to provide updates as received on the status. Meritain has provided a list of providers who have opted to negotiate directly with CHI linked below. Members who are impacted by this negotiation should have already received notification from CHI regarding the potential to be OON.
CHI Health Partners Affiliated Providers List Nov. 26, 2024.pdf<https://www.aetnacommercialbusinesses.com/Segments/2024/Providence_Network/…>
If you would like to review out-of-network costs, please see page ten of the attached benefit guide.
If you would like to look up in-network providers, use the Aetna Open Choice PPO network option here<https://www.aetna.com/dsepublic/#/contentPage?page=providerSearchLanding&si…>.
Please let me know if you have any questions!
Thank you,
Tara
Tara Johnson
Director of Operations & Benefits
State Law Enforcement Bargaining Council
STAN | NCOA | NSFMA
PO Box 6729
Lincoln, NE 68506
Phone: 402.489.2081
Cell Phone: 402.440.8284
Fax: 402.489.6093
This email may contain confidential and privileged information for the sole use of the intended recipient. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender and delete all copies.
