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 Continued on page 2 012964 (05-11-2009) 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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