One of our responsibilities as a Managed Care Organization is to strive for the highest quality health care at the lowest possible cost. In recent months, we have been attempting to negotiate a contract renewal with the Hospital Corporation of America (HCA) but to date we have been unable to reach mutually acceptable terms. We have enjoyed a long-standing partnership with HCA in Virginia, and we sincerely hope to continue our relationship. However, at this point I must make you aware that it is possible that HCA facilities in Virginia will no longer be in the Coventry Health Care network effective April 1, 2012.
What does this mean for your clients? We will send a letter notifying our mutual clients of this potential disruption on Tuesday, February 28. We will mail letters to members on or about March 1, 2012. Without resolution, HCA facilities will be considered out-of-network after April 1, 2012. Therefore, unless we have already approved an authorization, HMO members will not have benefit coverage for elective or scheduled services at these facilities. As always, HMO members may receive emergency medical treatment at the nearest available facility.
POS and PPO members may receive elective or scheduled covered care at one of the facilities listed below using out-of-network benefits. Payment for services will be based on non-participating care rates and paid directly to the member. It is possible members may be billed by HCA for charges in excess of our reimbursement rate. Since this will likely increase out-of-pocket expenses, we encourage members to discuss the possibility of using an alternative site with their doctor. Emergency services will not be affected by this network change.
The following is a listing of HCA facilities that may no longer be participating as of April 1, 2012. In addition, we have provided a listing of facilities that will continue to be In-Network that your employees may want to consider for their medical care.
RICHMOND
HCA Facilities
Chippenham and Johnston-Willis Hospital
Henrico Doctors' Hospital
John Randolph Hospital
Retreat Hospital
In-Network Facilities
Bon Secours Memorial Regional Medical Center
Bon Secours St. Francis Medical Center
Bon Secours Richmond Community Hospital
Bon Secours St. Mary's Hospital
Children's Hospital
MCV Hospital
Sheltering Arms Hospital
Southside Regional Medical Center
SOUTHWEST VIRGINIA
HCA Facilities
LewisGale Medical Center
LewisGale Hospital - Montgomery
LewisGale Hospital - Pulaski
LewisGale Hospital - Alleghany
In-Network Facilities
Alleghany Regional Hospital
Bedford Memorial Hospital
Carilion Giles Memorial Hospital
Carilion Franklin Memorial Hospital
Carilion New River Valley Medical Center
Carilion Roanoke Community Hospital
Carilion Roanoke Memorial Hospital
Memorial Hospital of Martinsville
NORTHERN VIRGINIA
HCA Facilities
Reston Hospital Center
In-Network Facilities
Inova Fair Oaks Hospital
Inova Fairfax Hospital
Loudoun Hospital Center
Members who are in an active course of treatment at an HCA facility will need to contact Customer Service to receive authorization to continue treatments during a transition of care period. Examples of treatments that may be allowed to continue are: pregnant members in their second or third trimester, members undergoing chemotherapy or Remicaid therapy, or follow-up care from a procedure performed at HCA (e.g., pins removed from a fracture). Decisions for scheduled services should be made between patients and their doctors.
We understand that this will inconvenience many of our members. If you have questions, please feel free to contact your account representative. As always, we endeavor to provide the consistency, reliability, and price stability you expect from a health insurer, and I regret this situation. Thank you for your partnership and support.
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