LifeWise Health Plan of Oregon SPECIAL Agent Bulletin ~ by elemnopey

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									                                                                                          Special Edition, May 11, 2009



                                      Provider Network Update
LifeWise Health Plan of Oregon remains committed to providing access to high-quality providers, while
maintaining responsible stewardship of our customers’ health coverage dollars. That commitment is rooted in
our belief that moderating the growth rate for healthcare costs is essential to the future financial viability of our
healthcare system. As part of this commitment, we want to let you know about a change in the network status of
Slocum Center for Orthopedics and Sports Medicine (Slocum) and their associated ambulatory surgery center,
Slocum Surgery Center (SSC) in Eugene.
Effective June 14, 2009 the contract between LifeWise, Slocum and SSC will expire. During the next week, we
are notifying employers and members who may be impacted by this network termination.

Managing Healthcare Dollars
LifeWise takes its responsibility to manage our customers healthcare dollars very seriously. We have an obligation
to employer groups and members to provide them with access to care at fair costs. At a time when healthcare costs
are driving higher benefit premium rates, it is essential for LifeWise to support a balance between access and
affordability.
Today, many of the services received at Slocum are more expensive than similar services provided by other
providers in the same geographic area.

Impact to Members
LifeWise members can continue to seek care from Slocum and SSC; however as of June 15, 2009, out-of-network
benefits will apply and the services delivered will result in higher out-of-pocket costs.
Out-of-network coverage is usually paid at a lower coinsurance percentage (e.g. 60 percent instead of 80 percent
coinsurance) and members may be held responsible for the difference between the amount billed by the provider
and the LifeWise Maximum Allowable Amount.
Also, when LifeWise processes claims for services from out-of-network providers, we mail the reimbursement
directly to the member. They will then be responsible to pay the provider directly.

Continuity of Care
LifeWise is committed to helping our members find or continue the care they need. The LifeWise provider
network includes other groups of orthopedists and orthopedic surgeons within reasonable geographic proximity
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Agent Bulletin | Special Edition | May 11, 2009                                                              Page 2


Continued from page 1, Provider Network Update


to Slocum and SSC should your clients require such care in the future. These groups include:
    •   Riverbend Pavilion Orthopedics
    •   PeaceHealth Medical Group
    •   Oregon Medical Group

Members can also refer to our online provider directory at www.lifewiseor.com where they will find the most
up-to-date provider information.

Communications
This week, we are notifying employers with employees or dependents who received care at Slocum or SSC in the last
12 months. Using the same criteria, individual and group members will also be receiving a notification this week.
Copies of these communications are included with this bulletin for your reference.
We appreciate the privilege of providing health plan benefits to your clients. Please know we remain committed
to providing a comprehensive and cost-effective provider network. If you have any questions, please contact your
LifeWise Health Plan of Oregon sales team.

								
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