February 11th 2019: For the past several months, we have been negotiating the terms of our agreements with Trinity Health (Trinity), which includes the following entities, as well as their professional providers, subsidiaries, affiliates, and divisions: Mercy Health System of Southeastern Pennsylvania, including Mercy Fitzgerald, Mercy Philadelphia, and Nazareth hospitals St. Mary Medical Center, including St. Mary Rehabilitation Hospital, Saint Francis Healthcare, including Saint Francis Hospital, Wilmington, Delaware. We continue to engage in good‑faith negotiations, but we want to explain how customers and members could be affected if we are unable to reach a new agreement by March 31, 2019.
How members would be affected
If we are unable to reach a new agreement, Trinity will no longer be a part of the Independence network as of April 1, 2019. However, members will continue to have access to other respected in‑network primary care and specialist physicians and hospitals in their community. We will work with Independence members and their health care providers to ensure a smooth transition, and we are committed to allowing for continuity of care if needed and in accordance with member benefits.
PPO, POS, and DPOS members can continue to receive care at Trinity facilities and from Trinity physicians on or after April 1, 2019, using their out‑of‑network benefit. However, their out‑of‑pocket costs may be higher than their in‑network benefits. HMO and EPO members will not be able to use their benefits at Trinity facilities or to see a Trinity physician on or after April 1, 2019, and will need to use health care providers in the Independence network.
PPO or EPO members who have received services at Saint Francis Hospital, or by a Saint Francis employed physician, may be able to continue to receive services at the hospital.
How we are notifying affected members and customers
We will send a letter and FAQ to members who have received care from Trinity in the last 12 months or have a received a prior authorization for surgery scheduled on or after April 1, 2019. We will also be mailing customers with affected members a letter about the potential network change this week. Updates on the status of the Trinity agreement will be postedat ibx.com/membersfirst.
As always, at Total Benefit Solutions, Inc. will do our best to keep you informed as updates become available. Feel free to reach out if you have any questions or concerns (215)355-2121