PEIA’s contract with the River Valley Health Alliance, which includes Marietta Memorial and Selby hospitals and their physician groups, will be terminated, effective June 30, 2010.
If you need to seek health care from an out-of-state provider, please call Wells Fargo at 1-888-440-7342 to assure that the provider is in PEIA’s network.
As of July 1, 2010, all providers in the River Valley Health Alliance will be considered out-of-network for PEIA members. However, you may request a prior authorization and if approved, the claim will be paid as at the higher benefit level. Otherwise, it will be processed at the lower benefit level. Emergency services do not require prior authorization.
As the cost of health care continues to rise, programs such as PEIA must make tough decisions about how to extend the highest levels of coverage possible while providing coverage to all members of the plan. This requires that we weigh the costs of benefits available to our members against how we can guarantee access to health care to all those that may need it.
PEIA has noted a substantially higher expense to cover care provided outside the state of West Virginia when compared to the cost of that same type and level of care within the state of West Virginia. Members who seek care out-of-state also run the risk of paying higher costs because providers outside of West Virginia that are not part of PEIA’s provider network are not subject to the “no-balance billing” rule. The “no-balance billing” rule protects you from being charged the difference between the provider’s total charge and PEIA’s payment on the claim. West Virginia providers and non-West Virginia providers that participate in PEIA’s provider network are subject to this rule. This protection does not extend to non-West Virginia providers that are not part of PEIA’s provider network.
We encourage you to seek care outside West Virginia only when necessary, and to use West Virginia providers whenever possible. If you have other questions about your out-of-state benefits, please refer to your Summary Plan Description for more details or call Wells Fargo at 888-440-7342.
River Valley Health Alliance Termination LetterRiver Valley Health Alliance Transfer FormWashington County Provider NetworkThe Health Plan Service Area