LMU Human Resources is aware that participants covered by Aetna (ALL Plans) who have designated a UCLA primary care physician received a communication over the weekend stating that effective April 7, 2023 UCLA will no longer be “in network providers.”
Aetna is in active negotiations with the University of California Health System to continue to cover Aetna participants for the entire state of California. Aetna is required by law to notify members in advance that failed negotiations will result in termination of the members’ Primary Care UCLA Physicians.
While Aetna continues active negotiations with the University of California Health System and remains optimistic that the parties will agree on contract terms prior to the termination date of April 7, 2023, despite the communication that was sent over the weekend, there remains a possibility that negotiations will continue up to, and possibly after, the termination date.
In the event of disruption we share the following:
Transition of Care
Aetna wants to help maintain continuity of care coverage if any members are currently undergoing treatment for serious illness, pregnancy or injury with a specialist affiliated with the affected facility. In such an instance, Aetna’s National Precertification clinical staff will review these cases and, when necessary, offer assistance to members who may require transition of care coverage by directing the member to Aetna Member Services or their online provider search tool at aetna.com.
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
- Previously scheduled surgery or other procedures
If any member requires frequent or continuing consultation with a specialist physician for ongoing covered care, the member should contact his or her current PCP who can help arrange transfer of that care to a similar specialist in the Aetna network. If the member does not have a relationship with a PCP, the member should check Aetna’s online provider search tool and other available resources to help find another specialist in the Aetna Network.
In addition, Aetna will help maintain continuity of care coverage if any members are currently undergoing treatment for serious illness, pregnancy or injury with a specialist affiliated with the affected facility. In such an instance, Aetna’s National Precertification clinical staff will review these cases and, when necessary, offer assistance to members who may require transition of care coverage by directing the member to Aetna Member Services or the Aetna provider search tool. For a limited time and when appropriate, Aetna will cover certain ongoing medical care for a serious illness for a specified period at the preferred level of benefits, rendered by a specialist who no longer participates in the network.
LMU Human Resources will aggressively explore other alternatives in the event negotiations between Aetna and the UC System fail. We recognize this is unsettling news and assure you we are working diligently to reduce any disruption a change may create.
Please contact HR@lmu.edu with any questions.