Aetna Termination

1. WHAT HAPPENED WITH AETNA?
San Joaquin Community Hospital’s contract with Aetna terminated on April 6, 2012.

2. IS MEDI-CAL AFFECTED?
Medi-Cal is not affected by the contract termination.

3. I’M VERY CONCERNED ABOUT THIS. WHAT CAN I DO?
If you receive healthcare coverage from your employer, your employer needs to know your concerns. Speak to your Human Resources department about your concerns.

4. WHAT IF I’M IN THE HOSPITAL WHEN THE CONTRACT TERMINATES?
If you’re an Aetna member and are undergoing inpatient care at San Joaquin Community Hospital on or after April 6, 2012, Aetna will most likely provide coverage until you’re discharged from San Joaquin Community Hospital at no cost differential to you resulting from the termination. You will need to confirm this by calling Aetna at the Customer Services telephone number on the back of your insurance card.

5. THE DUE DATE FOR MY BABY IS AFTER APRIL 6, 2012. CAN I STILL HAVE MY BABY AT SAN JOAQUIN COMMUNITY HOSPITAL USE MY AETNA INSURANCE?
You may be eligible to still deliver your baby at San Joaquin Community Hospital and receive post-partum care for you and your baby if you deliver after April 6, 2012 as “Continuity of Care Services” (with no payment differential resulting from the termination). You will need to get specific authorization from Aetna regarding these “Continuity of Care Services”. You should start this process by calling Aetna at the Customer Services telephone number on the back of your insurance card and you will need to confirm whether or not you will be considered “in-network” or “out-of-network” with respect to any out of pocket costs you may have with respect to your care.

6. WHAT IF I HAVE TO COME TO THE EMERGENCY ROOM? CAN I USE MY AETNA INSURANCE?
You can always come to San Joaquin Community Hospital for medical emergencies. ALWAYS go to the nearest hospital in an emergency, regardless of your insurance coverage or ability to pay. Your Aetna in-network benefits should apply.

7. I’M SCHEDULED FOR SURGERY OR A PROCEDURE AT SAN JOAQUIN COMMUNITY HOSPITAL AFTER APRIL 6, 2012. WHAT DO I DO?
You may be eligible to receive a surgery or procedure at San Joaquin Community Hospital (with no payment differential resulting from the termination) if the surgery or procedure was authorized and scheduled before April 6, 2012, (even if the surgery or procedure will take place within one hundred eighty (180) days after April 6, 2012) as a “Continuity of Care Service”. You will need to get specific authorization from Aetna regarding this “Continuity of Care Service”. You should start this process by calling Aetna at the Customer Services telephone number on the back of your insurance card and you will need to confirm whether or not you will be considered “in-network” or “out-of-network” with respect to any out of pocket costs you may have with respect to your care.

8. I’M RECEIVING CANCER CARE AT AT SAN JOAQUIN COMMUNITY HOSPITAL .WHAT DO I DO?
If you are already undergoing treatment for cancer or another chronic condition at San Joaquin Community Hospital you may be eligible to continue to receive treatment at San Joaquin Community Hospital (with no payment differential resulting from the termination) after April 6, 2012, as a “Continuity of Care Service”. You will need to get specific authorization from Aetna regarding this “Continuity of Care Service”. You should start this process by calling Aetna at the Customer Services telephone number on the back of your insurance card and you will need to confirm whether or not you will be considered “in-network” or “out-of-network” with respect to any out of pocket costs you may have with respect to your care.

9. MY FAMILY MEMBER WHO IS COVERED UNDER MY PLAN HAS A TERMINAL ILLNESS AND IS BEING TREATED AT YOUR HOSPITAL. WHAT CAN THEY DO?
Patients with a terminal illness may be eligible to continue to receive treatment at San Joaquin Community Hospital (with no payment differential resulting from the termination) after April 6, 2012, as a “Continuity of Care Service”. You will need to get specific authorization from Aetna regarding this “Continuity of Care Service”. You should start this process by calling Aetna at the Customer Services telephone number on the back of your insurance card and you will need to confirm whether or not you will be considered “in-network” or “out-of-network” with respect to any out of pocket costs you may have with respect to your care.

10. WILL MY CO-PAYMENT AND/OR DEDUCTIBLE INCREASE IF I GO TO SAN JOAQUIN COMMUNITY HOSPITAL FOR CARE?
Using a non-contracted or out-of-network hospital can increase a member’s out of pocket costs because their coinsurance and/or deductibles may be higher San Joaquin Community Hospital is committed to serving the members of the communities it serves during this difficult time and will therefore make every effort to work with each Aetna patient individually based upon their specific financial needs. Please contact Diane Johnson the Director of Patient Financial Services at San Joaquin Community Hospital at 661-869-6809 if you have concerns in this regard.

11. I WANT TO BE ABLE TO CONTINUE USING SAN JOAQUIN COMMUNITY HOSPITAL WHAT CAN I DO?
San Joaquin Community Hospital remains committed to the communities we are honored to serve so that those who want to continue to use San Joaquin Community Hospital may do so. We are prepared to work with those who may need to make special payment arrangements in order to continue using San Joaquin Community Hospital. Please contact Diane Johnson, the Director of Patient Financial Services at San Joaquin Community Hospital at 661-869-6809 if you have concerns in this regard.

Upon your request, we can provide you with a list of all the health plans and insurance carriers San Joaquin Community Hospital currently contracts or participates with as an in-network provider. If your insurance coverage is through your employer, you may check with your employer to see if it offers one of the other health plans or insurance plans San Joaquin Community Hospital currently contracts or participates with as an in-network provider.

12. I THOUGHT SAN JOAQUIN COMMUNITY HOSPITAL WAS HERE TO SERVE THE COMMUNITY. THIS IS ONLY HURTING THE COMMUNITY.
As a faith-based, not-for-profit health care provider, San Joaquin Community Hospital’s mission is to deliver compassionate quality care to the patients and communities it serves. Our first concern is always our patients. We sincerely apologize for any inconvenience the negotiation may have on you or family members. We have worked very hard to avoid this situation.

13. WHO CAN I CALL IF I HAVE MORE QUESTIONS?
You can contact Aetna Customer Service, using the number on the back of your insurance card. You can also speak to Diane Johnson, the Director of Patient Financial Services at San Joaquin Community Hospital at 661-869-6809. If your coverage is Aetna PPO, you may also contact the California Department of Insurance, which protects certain PPO consumers by calling its toll-free Consumer Hotline at 1-800-927-4357 or 1-800-482-4833 TDD. If your coverage is Aetna HMO, you may contact the California Department of Managed Health Care, which protects HMO consumers, by telephone at its toll-free number, 1-888-HMO-2219, or at a TDD number for the hearing impaired at 1-877-688-9891 or online at www.hmohelp.ca.gov.

14. DO YOU HAVE AETNA’S CUSTOMER SERVICE TELEPHONE NUMBER?
You can find this number on the back of your insurance card.