Dear Aetna Member,
I am writing to share potential changes that may impact your health care coverage. Please note this is only relevant for those members who use UCLA services.
Aetna is in active provider negotiations with UCLA Health. LMU is not a party to these negotiations. Both parties continue to have discussions in the hope of reaching a new contract and are aware of the dates and implications. If no agreement is reached, the contract terminates on April 7, 2023. Hopefully, they will reach agreement and no disruption will occur. They have also informed us that it is not unusual for provider negotiations to continue right up to the term date or beyond.
What does this mean for you?
Agreement is reached on or before April 7, 2023
- For those HMO members who, prior to April 1, have been automatically reassigned to a non-UCLA Primary Care Provider (PCP), the UCLA PCP will be automatically restored. If the changes are made by Aetna Managed Choice POS or Aetna Managed Choice HDHP members and new ID cards were sent out with the non-UCLA PCP, then any change back to a UCLA PCP would need to be member initiated.
Agreement is not reached on or before April 7, 2023
- For Aetna members enrolled in the HMO Plan you will no longer have access to UCLA providers and services.
- For Aetna members enrolled in the Aetna Managed Choice POS and Aetna Managed Choice POS HDHP, UCLA services will be considered as out of network services.
- Aetna maintains an extensive provider network which will allow for continued coverage. However, we do not underestimate the impact this may have on you and your family members.
- There are “transition of care” benefits applicable to all Aetna Plans to help maintain continuity of care coverage for those members who are currently undergoing treatment.
- Aetna’s California addendum to its standard Transition of Care Coverage policy provides for completion of covered services for: acute conditions, severe chronic conditions, pregnancy, terminal illness, the care of a child ages 0-36 months, and previously scheduled surgery or other procedures.
Agreement is not reached on or before April 7, 2023, but occurs at a later date
- This will allow for members to return to their UCLA providers. Members must initiate the change back to their UCLA PCP. Again, we understand that this is less than optimal.
Following are two common questions that have been asked during this process:
Q: Is this considered an event that would permit changing Plans?
A: No, this is not a permitted mid-year election change pursuant to federal and state regulations. As a reminder Open Enrollment occurs each November for changes effective January 1.
Q: Was LMU aware that Aetna’s contract with UCLA would be expiring?
A: No, it would be highly unusual for this information to be routinely shared. Carrier contracts are proprietary information, and Anthem too periodically engages in provider negotiations, as does any health insurance carrier.
We will share updates as soon as more information becomes available. In the meantime, Human Resources is continuing to explore other options. Please contact hr@lmu.edu with any questions.
Thank you again for your continued patience.
Sincerely,
Rebecca Chandler
Vice President, Human Resources
