Dear Aetna Member,
As promised, we are keeping you informed on progress that has been made during Aetna’s negotiations with the UCLA Health System. Aetna has received another extension from the UCLA Health System with a new term date of April 21, 2023. Aetna will continue to negotiate in hopes of coming to an acceptable agreement. As a reminder, this is only relevant for those members who use UCLA services.
If You're Receiving Ongoing Treatment
If you are in an active course of treatment through a UCLA network provider who is no longer going to be a part of the Aetna network in the event an agreement is not reached, you may be eligible to continue receiving care from your current provider for the remainder of your treatment. You must submit a Transition Coverage Request form (see below) to Aetna and Aetna must approve that request.
If approved, you would be able to continue seeing the non-contracted provider at the in-network level of benefits through the remaining course of treatment. Transition of care (TOC) extensions are typically 90 days, but can vary based on the condition and circumstances. The TOC approval will indicate how long of an extension has been granted. You would still have access to a Case Manager and Concierge to assist with coordination of care.
Conditions for which an active course of treatment may apply include:
- A disabling medical condition
- Serious mental illness due to a disease, or serious medical problems that require ongoing treatment to maintain remission or prevent deterioration
- The third trimester of pregnancy
- Surgeries scheduled within the next six months
- Ongoing chemotherapy or radiation therapy
How to Apply for Transition of Care
- Download the appropriate Transition Coverage Request form:
- If you have an Aetna HMO: HMO Transition Coverage Request form
- If you have either the Aetna Managed Choice POS or the Aetna Managed Choice POS HDHP: CA OAMC Transition Coverage Request form - Complete sections 1 through 3 of the form.
- Give the form to your health care provider to complete section 4.
- Fax the completed form to Aetna at 859.455.8650 for review or you can also send your form to hr@lmu.edu.
- Aetna will send you a letter explaining their decision on your request.
How to Choose a New Health Care Provider
To find a new participating provider, please visit aetna.com and click on 'Find a doctor' for a list of doctors in your plan's network. If the provider is a specialist, ask your Primary Care Physician to refer you to another in-network specialist. You can also call our Member Services number on your ID card to help you choose a new Primary Care Physician.
Please contact LMU Human Resources at hr@lmu.edu with any general benefits questions. Thank you again for your continued patience.
Sincerely,
Rebecca Chandler
Vice President, Human Resources
