To: ILWU Southern California Locals 13, 26, 29, 46, 63, 94

Transcription

1 Date: December 13, 2016 To: ILWU Southern California Locals 13, 26, 29, 46, 63, 94 From: Subject: Mario Perez, Manager, Welfare Plans Notice to All Southern California Participants Enrolled in the ILWU-PMA Coastwise Indemnity Plan or Kaiser Health Plan The enclosed notice is being mailed to all eligible Southern California Participants enrolled in the Coastwise Indemnity Plan and the Kaiser Health Plan. cc: Sam Alvarado, Area Welfare Director Attachment A copy of this memo can be downloaded at MP:nt/opeiu29aflcio/MTP-Provider Terminations-V

2 December 13, 2016 To: All Southern California Participants and Beneficiaries Enrolled in the ILWU-PMA Coastwise Indemnity Plan or Kaiser HMO Plan Please take notice that the Trustees of the ILWU-PMA Welfare Plan ( Plan ), who have sole authority to administer the Plan, have determined that the Plan will not reimburse any Plan Participants or otherwise pay benefits for any claims for services, supplies, tests, or prescriptions provided to any Plan Participant or beneficiaries by providers: Mansoureh Barahemi, D.C., Darren N. Hines, D.C., Michael Charles Edwards, M.D., Patricia A. Washington, M.D., Youssef Lalezarian, M.D., Boniface O. Onubah, M.D., Saeed (Sid) Kamrava, M.D., Artis Woodward, M.D., Susan Seideman, M.D., and Marc Richard Rose, M.D., or any healthcare providers working under the direction or supervision of these doctors for services on or after January 13, On the back of this page and on the additional pages is a list of organizations that may be associated with these named providers. When utilizing these facilities ask whether the above physicians are associated in any way with your treatments. A complete and current list of all providers and healthcare facilities whose services and prescriptions the Plan will no longer cover is posted on the Plan s website, Please consult the website or telephone the Benefit Plans Office at (415) to get the most current information regarding providers and facilities which are no longer covered. - List of affected providers and additional information on back and additional pages - (over) 1

3 Mansoureh Barahemi, D. C.: Please note, this provider will no longer be covered under the Coastwise Indemnity Plan or Chiropractic Benefit effective January 13, o Natural Health Chiropractic o Image Chiropractic Clinic o 1100 W. Town and Country Rd., #50, Orange, CA o S. Western Ave., #152, Rancho Palos Verdes, CA o S. Western Ave., #153, Rancho Palos Verdes, CA o 1861 N. Gaffey St., Stes. G & H, San Pedro, CA o PO Box 2208, Orange, CA Darren N. Hines, D. C.: Please note, this provider will no longer be covered under the Coastwise Indemnity Plan or Chiropractic Benefit o Training Room Unlimited o Quest Chiropractic o 1157 Long Beach Blvd., Long Beach, CA o 522 W. 9th St., San Pedro, CA o 3756 Santa Rosalia Dr., Ste. 505, Los Angeles, CA o Bellflower Blvd., Bellflower, CA o Devonshire St., Mission Hills, CA o S. Clark Ave., Ste. D, Bellflower, CA Michael Charles Edwards, M. D.: Please note, any claim from a facility or from any other provider related to a service in which this provider participates will not be reimbursed Associated organization: Michael C. Edwards, M.D., Ph.D., Inc. o Beach Blvd., Ste. A2, Westminster, CA o Hawthorne Blvd., Lawndale, CA o 1440 E. 1st St., Ste. 100, Santa Ana, CA

4 Patricia A. Washington, M. D.: Please note, any claim from a facility or from any other o 11 Corn Flower St., Coto De Caza, CA o 1310 W. Stewart Dr., Ste. 210, Orange, CA Youssef Lalezarian, M. D.: Please note, any claim from a facility or from any other o 165 S. Layton Dr., Los Angeles, CA o 1740 S. Los Angeles St., Ste. 104, Los Angeles, CA o 5995 Topanga Canyon Blvd., Woodland Hills, CA Boniface O. Onubah, M. D.: Please note, any claim from a facility or from any other o Boniface O. Onubah, M.D., Inc. o Boniface O. Onubah, M.D. Incorporated o 1812 W. Burbank Blvd., Ste. 8, Burbank, CA o Maxella Ave., #909, Marina del Rey, CA o Magnolia St., Ste. 101, Westminster, CA o 2501 W. Burbank Blvd., #308, Burbank, CA o Ventura Blvd., #47526, Woodland Hills, CA Saeed ( Sid ) Kamrava, M. D.: Please note, any claim from a facility or from any other o Enhanced Aesthetics & Gynecology o Rejuvenation Surgicenter o Tarzana Garden OB/GYN 7525 Ventura Blvd, Ste. 101, Encino, CA

5 Artis Woodward, M. D.: Please note, any claim from a facility or from any other provider related to a service in which this provider participates will not be reimbursed effective January 13, Associated providers and organizations: o Artis Woodward, M.D., Inc. o Artis Woodward, M.D., A Professional Medical Corporation o Artis Woodward, M.D., A Professional Corporation o Modern Medicine, Inc. o Sunrise Surgery Center o Clover Surgical Center, Inc. o Westview Medical Clinic, Inc. o 4477 W. 118th St., Ste. 300, Hawthorne, CA o 2120 W. 8th St., #330, Los Angeles, CA o Ventura Blvd., Ste. 110, Tarzana, CA o B. Brokehurst St., Mountain Valley, CA o 6340 Green Valley Cir., Ste , Culver City, CA o 8700 Warner Ave., Ste. 200, Fountain Valley, CA o Kiwi Ln., Garden Grove, CA o 8342 Garden Grove Blvd., #10, Garden Grove, CA o Victory Blvd., Stes. E & F, North Hollywood, CA o 1800 Truman St., Irvine, CA o 6709 La Tiejera Blvd, Ste. 118, Los Angeles, CA o 5235 Melrose Ave., Los Angeles, CA o 1201 N. Pacific Ave., Glendale, CA Susan Seideman, M. D.: Please note, any claim from a facility or from any other Associated organization: Susan E. Seideman, M.D., P.C. o Avalon Blvd., Ste. 105, Carson, CA o 2014 Vanderbilt Ln., Redondo Beach, CA Marc Richard Rose, M. D.: Please note, any claim from a facility or from any other Associated organization: Susan E. Seideman, M.D., P.C. o 3420 Bristol St., Ste. 700, Costa Mesa, CA o 3151 Airway Ave., Ste. M-3, Costa Mesa, CA