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Aetna

Protecting your healthcare access and choice.

At Dignity Health, we believe every patient deserves access to high-quality healthcare from the providers they know and trust. Dignity Health is actively negotiating with Aetna in good faith to renew our commercial HMO, POS, PPO, Medicare Advantage and Aetna Whole Health provider agreements in California, Arizona and Nevada. If new agreements aren’t reached, our California, Arizona and Nevada Dignity Health Hospitals, Physician Groups, Clinics and Ancillary providers will no longer participate in Aetna's network at 11:59 p.m. on March 31, 2024.

The only exceptions are for California HMO members assigned to Dignity Health Medical Groups listed below:

Expires 11:59 p.m. on June 30, 2024:

  • Mercy Medical Group
  • Woodland Clinic
  • Dignity Health Medical Network - Central California (may also be listed as GemCare or Independence Medical Group)
  • Dignity Health Medical Network - Santa Cruz

No expiration:

  • Dignity Health Medical Network - Ventura (CA)
  • Yavapai Regional Medical Center - Arizona
  • Saint Francis Memorial Hospital - San Francisco (CA)
  • St. Mary's Medical Center - San Francisco (CA)
  • SFO Clinic - San Francisco (CA)
  • Sister Mary Philippa Clinic - San Francisco (CA)
  • Dignity Health Medical Group St. Francis/St. Mary's - San Francisco (CA)

Nothing will change before April 1, 2024. Please keep any appointments and procedures you have authorized and scheduled with Dignity Health hospitals, physicians, surgery centers, and other providers. Do not delay routine health screenings, procedures, or tests that are vital to your health. 

For services authorized and scheduled to occur on or after April 1, 2024, patients should complete and submit Transition Coverage Request (Continuity of Care) forms to Aetna to ensure that the procedure will be authorized at a Dignity Health facility. Patients should contact Aetna to determine if the procedure will be authorized at a Dignity Health facility. Please remember emergency care at all hospitals will be covered by Aetna for their members, regardless of network status.

Members should contact Aetna for any services to be authorized and scheduled on or beyond April 1, 2024 to determine whether continuity of care will be approved. If Aetna members have additional questions, they should contact Aetna, or a Dignity Health Customer Service Representative at 877-729-2669 for further assistance.

Questions and Answers

Over the last several months, Dignity Health has been negotiating in good faith with Aetna to reach a new, responsible contract agreement that puts patients’ needs first and ensures their continued in-network access to Dignity Health providers and services. Our goal in working with Aetna is to protect patients’ access to our physicians, hospitals, and other vital health care services while ensuring our ability to continue providing quality services now and in the future.

If Aetna is unwilling to work with Dignity Health, our hospitals, physicians, surgery centers (in CA and NV), and other providers will no longer be in-network with Aetna beginning April 1, 2024. Nothing will change before April 1, 2024. You should keep any appointments and procedures you have scheduled with Dignity Health hospitals, physicians, surgery centers, and other providers. Please do not delay routine health screenings, procedures, or tests that are vital to your health.

Yes, patients will still be able to access care from Dignity Health. However, Aetna will consider Dignity Health physicians, providers and services out-of-network, limiting patient access and choice. Depending on each patient’s benefits, out-of-network services may not be covered, or may result in a higher cost. Contact Aetna to ensure the service would be authorized with your Dignity Health provider.

Dignity Health strongly desires to continue caring for patients with Aetna insurance. We are negotiating with Aetna in good faith, and it is our hope that before April 1, 2024 Aetna will agree to a new, responsible contract that puts patients first.

  • Call Aetna at the number on the back of your insurance card and urge them to work with Dignity Health on a new agreement.

  • Visit www.DignityHealth.org/aetna to stay updated on our negotiations.

  • Call Dignity Health at 877-729-2669 to learn more about your health insurance options.

  • Consider Continuity of Care: If you are currently in active treatment, have appointments or procedures scheduled, or have been treated by a physician over the last several months, you may qualify for protected in-network access through Continuity of Care benefits. Continuity of Care is a benefit intended to protect patients from having to change providers or having care delayed or disrupted if an agreement between a health plan and provider is terminated. For questions about Continuity of Care eligibility, benefits, or access to the form, please call Aetna using the number on the back of your insurance card and ask for their Transition Coverage Request (continuity of care) form. This form can also be found on Aetna's website.

Dignity Health is actively negotiating with Aetna for commercial HMO, POS, PPO, Medicare Advantage, and Aetna Whole Health for Dignity Health providers across California, Arizona, and Nevada. In the absence of new agreements, the majority of our California, Arizona, and Nevada agreements are set to terminate at midnight on March 31, 2024. 

For services prior to 4/1/2024, nothing is changing; patients should continue to work with their care providers to schedule services. We encourage our physicians to try to schedule elective procedures prior to the Term Date. For services scheduled to occur on or after the Term Date, patients should complete and submit the Transition Coverage Request (continuity of care) form for continuity of care services to Aetna to ensure that the procedure will be authorized at a Dignity Health facility.

For services on or beyond 4/1/2024,

  • If patients have out-of-network coverage and they decide to use that benefit, they must educate themselves about the potential impact to their out-of-pocket costs (i.e. higher co-insurance, copayments, and deductible amounts). 

  • To secure continuity of care coverage for services on or after 4/1/2024, patients will need to download and complete Aetna’s Transition Coverage Request (continuity of care) form from the Aetna website for members, and submit it to Aetna no later than 6/29/2024. Our providers may assist with completing and submitting the form if needed as well as providing any requested medical records.  

  • California HMO TCR Form:
    https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/individuals-families-health-insurance/document-library/ca_hmo_transition_care_cov_policy.pdf

  • California Traditional TCR Form:
    https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/individuals-families/document-library/ca-traditional-transition-care-cov-policy.pdf  

  • Arizona and Nevada TCR Form:
    AZ/NV members need to contact Aetna directly at the number on the back of their insurance card to obtain access to the form.

  • Please note that some employers may have different Transition Coverage Request forms and deadlines for submitting such forms for continuity of care. Patients who obtain health insurance through their employer will want to contact their employer first to determine if they need to use a specific form and confirm the filing deadline.

Please note for all three states: Health plan in-network benefits for all emergent services apply to services provided by any hospital emergency room regardless of the hospital’s contract status with the health plan.

Patients should contact the Aetna customer service department using the number on the back of their member identification card.