Jan 05, 2022
Recently, Aetna notified you that they are in active contract negotiations with the Optum Group for the following medical groups for HMO members: AppleCare, Monarch, and PrimeCare Medical Group. They have not reached an agreement and members have been moved to other providers in the HMO networks effective January 1, 2022.
In addition, Aetna received notice of termination effective January 1, 2022 from Optum for members enrolled in PPO/OAMC/Savings Plus/EPO networks for the following medical groups: Beaver Medical Group, LPT; Optum Medical Group dba Centers for Family and Redlands Family Practice. Members who have seen a provider two times in the past twelve months will receive a letter notifying them the provider is no longer in the network.
Aetna is committed to helping members access quality health care that is cost-effective. Aetna understands the importance of providing its members with access to low-cost care that is local, simple and helps them achieve better health. While they would like Optum to remain in network, they have a network of health care providers that can meet members’ health care needs in the communities where Optum operates.
HMO members
Aetna sent letters to HMO members assigned to a Primary Care Physician (PCP) with PrimeCare Medical Group, AppleCare and Monarch regarding a potential provider termination on November 5, 2021. During the next few days, members will receive a new ID card with a new PCP assignment based on their location. If a member wishes to change the PCP they were assigned, they should contact Member Services at the number listed on their ID card.
The following HMO products/networks are impacted by the negotiations with Optum for PrimeCare Medical Group, AppleCare, and Monarch:
- HMO
- HMO Deductible
- Aetna Value Network
- Aetna Whole Health Southern CA HMO
- Basic HMO
PPO members
In addition to the HMO products/networks listed above, providers employed by the groups listed below will be removed from the PPO/OAMC/Savings Plus/EPO networks. If the providers are contracted with Aetna directly, they will remain in the network.
- Beaver Medical Group, LPT – Banning, Cooley Ranch, Highland, Redlands and Yucaipa locations
- Optum Care Medical Group – dba Centers for Family
- Redlands Family Practice
Some members may qualify for “transition of care coverage.” This means they may be able to stay with their present provider if they have already started treatment.
In some cases, members may be able to keep going to their current provider to complete a treatment or to receive treatment that was already scheduled. This is called continuity of care. Care will continue during a transitional period that will vary based on their condition. The member or their provider should call Aetna for approval to continue any care.
Members can find this information in their Evidence of Coverage (EOC). Refer to the section entitled, “Who provides the care - keeping a provider you go to now (continuity of care)” for details.
View, download, or print the Transition of Care policy here, which explains the specific conditions for which Aetna will provide continuity of care. The member or the member’s provider must complete a Transition Coverage Request form and send it to Aetna. To get the form or their questions answered about continuing care, members can call 1-800-445-5299.
The form must be submitted within 90 days from the date their provider’s contract ends and before they receive services.
Contact your Amwins Connect Regional Sales Manager for more information.
