In the fall of 2009, Blanchard Valley Hospital and Bluffton Hospital were notified that Aetna Medicare PPO would be the new health plan for STRS and SERS retirees and Humana Medicare Advantage PPO would be the health plan for OPERS retirees. Since that time, BVHS has been in negotiations with Aetna and Humana to join their Medicare PPO networks.
Blanchard Valley Hospital and Bluffton Hospital are not currently in the Medicare network for either plan. However, we have been informed of a grace period for enrollees to use the hospitals without any out of network penalty or problems.
- Aetna Medicare PPO claims for STRS and SERS will be paid at in-network benefit levels. According to benefit information available online from STRS and SERS, there is no penalty for using a non-network provider unless the provider does not accept regular Medicare reimbursement.
- Humana Medicare Advantage PPO has a one-year transition period that the member is able to use any provider who accepts Humana's "private fee for service product" during 2010.
We continue to work with both Aetna and Humana to work out the contract terms to potentially join the network for each plan, but we do not know when those negotiations will conclude.
Questions? Call Gina Fischer in the BVHS Managed Care Department at (419) 423-5262.
