AETNA-Dignity Agreement - 2021
As of March 31, 2021, Dignity Health is no longer contracted with Aetna Commercial and Aetna Medicare plans. This impacts Arizona, California and Nevada.
Dignity Health's Arizona, California, & Nevada providers, including hospitals, ASCs, clinics, and physician groups, are considered "Out of Network". The only exceptions that we know of are for Yavapai Regional Medical Center (East and West Campuses) and Yavapai Regional Medical Group.
This does not affect your Aetna contract, if you have one. However, it does mean that you may be required to obtain out of network authorizations to perform work at out of network facilities.
What this means for you:
Emergency services will not be impacted -- Aetna members may continue to access any hospital for emergency-related care, whether the provider is In-Network or Out-of-Network.
If hospital services are required for an elective service or procedure, please instruct your office staff to call Aetna directly to determine whether or not the elective service or procedure may be performed at a Dignity Health facility. Authorizations are critical for any elective services.
Authorizations
Authorized prior to 4/1/21:
Will be honored by Aetna – patient’s in-network benefits shall be applied & claims shall be paid at existing contract rates – without the need for a Transition of Care (TOC) form for services that occur within the following timeframes beyond 4/1/21:
Acute Hospitals: 30 calendar days
AZ & CA Professional: 365 calendar days, or members’ plan anniversary (earliest of either)
New authorization requests post 4/1/21:
Important to note that Aetna & Aetna’s delegated providers (e.g. Non-Dignity Health capitated medical groups) are now redirecting care/not issuing new authorizations.
Patients with an Aetna approved TOC would be exceptions to this rule.
Transitions of Care Policy (“TOC”) - Certain medical conditions including acute services needing ongoing treatment, chronic conditions, previously authorized services, and maternity-related care may be eligible for continued care at a Dignity Health facility. Aetna members who want to access or continue services from a Dignity Health facility are required to initiate and submit a TOC request to Aetna within 90 days (by June 30, 2021).
Please note both you as the provider and the patient must sign the submitted TOC form.
If you only have Privileges at a Dignity Health Facility:
You may have already received a notice from Aetna if you only have privileges at a Dignity Health hospital. If so, you have 90-days from April 1, 2021 (by June 30, 2021) to obtain privileges at an in-network hospital, or Aetna ay have the ability to terminate your agreement.
If you have any questions on obtaining privileges at an Aetna in-network hospital, please let us know and we are happy to provide and work with you on obtaining privileges at another facility.
If you have any questions or would like to discuss further, please let us know and we are happy to schedule a time to connect.