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For the past several months, we have been
negotiating the terms of our agreements with Trinity Health (Trinity),
which includes the following entities, as well as their professional
providers, subsidiaries, affiliates, and divisions:
- Mercy
Health System of Southeastern Pennsylvania, including Mercy
Fitzgerald, Mercy Philadelphia, and Nazareth hospitals
- St.
Mary Medical Center, including St. Mary Rehabilitation Hospital
- Saint
Francis Healthcare, including Saint Francis Hospital, Wilmington,
Delaware
We continue to engage in good-faith negotiations, but we want
to explain how customers and members could be affected if we are unable to
reach a new agreement by March 31, 2019.
How members would be
affected
If we are unable to reach a new agreement, Trinity will no
longer be a part of the Independence network as of April 1, 2019. However,
members will continue to have access to other respected in-network primary
care and specialist physicians and hospitals in their community. We will
work with Independence members and their health care providers to ensure a
smooth transition and we are committed to allowing for continuity of care,
if needed and in accordance with member benefits.
Here's how members would be affected, according to the plan they have:
- PPO,
POS, and DPOS members can continue to receive care at Trinity
facilities and from Trinity physicians on or after April 1, 2019,
using their out-of-network benefit. However, their out-of-pocket costs
may be higher than their in-network benefits.
- HMO
and EPO members will not be able to use their benefits at Trinity
facilities or to see a Trinity physician on or after April 1, 2019,
and will need to use health care providers in the Independence
network.
- PPO
or EPO members who have received services at Saint Francis Hospital,
or by a Saint Francis employed physician, may be able to continue to
receive services at the hospital or from the physician at in-network
cost-sharing under the nationwide BlueCard® program.
How we are notifying affected
members and customers
We will send a letter
and FAQ
to members who have received care from Trinity in the last 12 months or
have a received a prior authorization for surgery scheduled on or after
April 1, 2019.
We will also be mailing customers with affected members a
letter about the potential network change this week.
Updates on the status of the Trinity agreement will be posted
on the main IBX Medicare Find
a Doctor or Pharmacy page.
Next
steps
If you have any questions, please reach out
to the Broker Medicare Resource Center with questions or to request further
information.
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