Q. What has changing this year?
A. The Adena Care Network will still provide the highest coverage for services provided at Adena Health System. That part has not changed. For 2022, the Adena Care Network will be partnering with the Ohio State University Health Plan (OSUHP) Network to provide services beyond the scope of services provided by Adena Health System at a greater benefit level to members. This tier includes all Ohio State University Wexner Medical Center facilities (OSUWMC), Nationwide Children’s Hospital (NCH), and Central Ohio Primary Care Physicians (COPC). The Anthem Network is still available at a lesser benefit. There is no out-of-area coverage beginning January 1, 2022.
Q. What are the differences between networks?
Adena Care Network • Adena Health System providers • 100% Preventive Care • 95% Coverage for Specialists and Other Services (after deductible is met) • Lowest deductibles and max out-of-pocket costs | OSUHP Network • OSUWMC, NCH, COPCP, other select community providers • 100% Preventive Care • 90% Coverage for Specialists and Other Services (after deductible is met) • Lower deductibles and max out-of-pocket costs | Anthem Network • Various Other Community Providers • 100% Preventive Care • 65% Primary Care, Specialists and Other (after deductible is met) • Higher deductibles and annual max out-of-pocket costs |
Q. Why are we making this change?
A. We continually look for ways to provide our members the best care with a variety of options to meet their needs within their budget. Enhancing the provider network and encouraging plan members to use Adena Care Network and OSUHP providers will help: • Help improve health outcomes • Reduce costs for members and the health plan • Take full advantage of the local world-class resources available to our members through our unique relationship with OSUHP, while still preserving provider choice for members.
Q. How will this specifically benefit members and the plan?
A. Instead of your doctors and other caregivers working in silos between multiple health systems, your providers can coordinate your care and provide you with better outcomes • Better coordinated care for managing chronic conditions • Lower costs by reducing duplicate or un-needed tests through the integration of the electronic medical record
Q. Will this change in our network affect my deductible or the out-of-pocket maximum of the health plan?
A. The deductibles and out-of-pocket maximums will not change in 2022 for the Adena Care Network and the OSUHP Network tiers. What is changing is the benefit coverage, 95% coinsurance, when you use an Adena Care Network provider. Additionally, services from the OSUHP Network will be paid at 90% coinsurance under the same deductible and out-of-pocket maximum as the Adena Care Network.
Q. What should I be doing now because of this change?
A. If you exclusively use Adena Care Network providers, you don’t have to do anything and you will continue to benefit from the lowest out-of-pocket costs for your health care. That means the majority of our current members will not impacted because of their use of the Adena Care Network for their health care services. You can verify what physicians and advanced practice providers (APPs) who participate in the Adena Care and/or the OSUHP provider by checking the 2022 Adena Health Plan Provider search tool. If you currently use a physician, APP, or facility that is out-of-network with Adena Care, OSUHP, and Anthem networks, there is no coverage for services and the member will be responsible for 100% of the cost of care. Emergency care is covered at the OSUHP Network coverage level of 90% outside of the networks. Example: If you are on vacation and have an accident and must use a service that is not in the Adena Care or OSUHP Networks, services are covered at 90%.
Q. What happens if I do use a provider who is in the Anthem Network and want to continue using that provider?
A. You don’t have to do anything. You can choose to continue using that provider; however, you should note where there are differences in the level of benefit coverage provided for the Anthem Network providers starting on January 1, 2022.
Q. What should I do if I use an Anthem Care Network provider and want to change to an Adena Care or OSUHP Network provider?
A. If you would like to switch to an Adena Care Network or OSUHP Network provider, you can search for providers near you using the 2022 Search Tool. You may also contact 740-779-FIND (3463) to locate a physician or APP in the Adena Care Network to assist with transitioning to an Adena Care or OSUHP physician or APP. You should also consult with your primary care physician if you would like to change specialists. Both Adena Medical Group and OSUWMC offer a comprehensive array of specialty physicians and APPs. Members seeking to establish care with a new provider can get priority service by mentioning they are members of the Adena Health Plan. If you have any issues finding a provider or have other questions, you can contact the Adena Care Concierge Team at 740-772-CARE (2273) or via email at adenacare@adena.org for personalized assistance. Members wishing to see a COPCP provider can contact them at 614-326-4646 and speak to a member of their Concierge Service for assistance in scheduling.
Q. I’m not sure what to do. What help is available to me?
A. Please review the information that was sent to your home. If you still have questions, please contact Adena Care Concierge at 740-772-CARE (2273) for assistance.
Q. What is Adena Health Plan Concierge Services?
A. Adena Health Plan Concierge Services are dedicated customer service specialists who are specifically trained to not only answer your health care benefit questions but help guide you through the complexities of claims and coverages. We have expanded the team to offer comprehensive support when you have a question. You can contact the team to: • Find providers in the Adena Care and OSU Health Plan Network. • Assistance in scheduling with Adena and OSUWMC providers. • Learn about your deductible, plan coverage information and cost of care. • Assistance with billing issues, denials, and pre-service requirements.
Hours: Monday – Friday | 7:30 a.m. – 5 p.m. ET
Phone: 740-772-CARE (2273)
Email: adenacare@adena.org
Q. How were physicians and APPs assigned to the networks?
A. Our best opportunity for integrated (or coordinated) care is to leverage our relationship with OSUHP Network providers, so we started building the network from there, working closely with the OSUHP. In determining network tiers within Adena Health System service region and its adjacent counties, we evaluated geographical access, timeliness access, provider capacity by specialty, quality, and opportunities to support more integrated care delivery. As a result, we added the COPC providers and other select community providers.
Q. Will my premiums increase for 2022 health plan coverage?
A. There is no increase to the 2022 Adena Health Plan premiums. Adena Health System understands the impact the pandemic has taken on our caregivers and this is another way to say thank you for all that you do every day caring for our communities and each other.
Q. How does the cost and quality of Adena Care and OSUHP Network providers compare to other providers?
A. You will receive the highest level of benefit coverage when using the Adena Care and OSUHP Network providers. All providers are credentialed and contractually held to quality standards.
Q. What do I do if I can’t get an appointment with an Adena Care or OSUHP provider?
A. You should contact Adena Care Concierge Services at 740-772-CARE (2273) 8:00 a.m. to 4:30 p.m. Monday- Friday. We have expanded our customer service team to offer more comprehensive, personalized support whenever you have a question or need help getting an appointment particularly at Adena Health System and Ohio State University Wexner Medical Center. You can also contact Concierge Services to learn about your deductibles, plan coverage, and cost of care.
Q. How are you addressing access issues, especially for OSUWMC specialty providers who already have long wait times for just to get a visit?
A. Members seeking to establish care can get priority service with OSUWMC and Central Ohio Primary Care providers. The OSUWMC provider network is also growing. In just the past two years, they have added providers in both primary care and specialties, and they are continuing to grow.
Q. Will the network change affect my coverage when I or my covered dependents are traveling?
A. Emergency care is covered at the OSUHP Network coverage level of 90% outside of the networks. Example: If you are on vacation and have an accident and must use a service that is not in the Adena or OSUHP Networks, services are covered at 90%.