Use of the Emergency Room at Mercy St. Anne Hospital in Toledo by Dr. James King, UT-AAUP Health Benefits Consultant The University was advised by the FrontPath Network, the Preferred Provider Network involved in our OBA/FrontPath health plan, that there is no longer a contract with the Emergency Room Physicians at the Toledo based Mercy St. Anne's Hospital. This has an important implication for each member using the OBA Health Plan. Specifically, should you go to the EMERGENCY ROOM at St. Anne Hospital, the Plan will be charged for the physician portion of the bill at the NON-NETWORK level. As you are most likely aware, this means that you personally have no protection against the physicians balance billing you. The Plan reimburses all emergency rooms not "In-Network" by paying at the Usual, Customary and Reasonable (UCR) rate. However, you would pay the normal Plan In-Network fees, that is, a $75.00 facility fee plus 90% of the bill, after the deductible, until you reach the maximum co-insurance limit. However, since the St. Anne physicians are no longer In-Network, you will no longer be protected from paying only paying your normal use charges, but for the physician charge (now Out-Of-Network) which means the coinsurance limit for that portion of the bill is not $1,000.00 but $4,000.00. This change in Network composition becomes effective September 30, 2012. There are several alternatives that are IN-NETWORK that you may use as an alternative to the St. Anne Emergency Room. Here is a listing with the associated mileage. |
Alternative Urgent and Emergency Service Providers | |
Provider |
Distance from St. Anne |
Provider |
Distance from St. Anne | |
ProMedica Urgent Care 4235 Secor Rd.
Toledo, Ohio
|
0.3 mile |
The Toledo Hospital 2142 N. Cove Blvd.
Toledo, Ohio
|
2.3 miles | |
Flower Hospital
5200 Harroun Rd.
Sylvania, Ohio
|
4.5 miles |
Sylvania Urgent Care LLC
4405 N. Holland Sylvania Rd., Ste. 101
|
3.9 miles |
Please note that all other services provided by the St. Anne hospital, other than the ER physician charges, are billed at the IN-NETWORK rate. This decision does not reflect on the competence of the ER physician staff. Rather, these physicians work through a contract with a California based physician service (Synergy). This service charges exorbitant fees for the physician services and has been unwilling to provide such services at a reasonable rate more in line with all the other emergency room rates in the Northwest Ohio area. |
