Health Alliance sues over insurance procurement
SPRINGFIELD — Health Alliance Medical Plans is asking a judge to overturn the health plan enrollment process that has state employees and retirees up against a June 17 deadline.
The Urbana insurer filed a lawsuit late this afternoon in Sangamon County Circuit Court against the state and several departments and officials involved in the state's managed care plan vendor selection. The suit also names several insurance bidders — including Blue Cross and Blue Shield of Illinois, Humana, PersonalCare, and HealthLink.
Health Alliance is asking the court to declare that a fair and legal bidding process wasn't conducted, and to order Department of Healthcare and Family Services Director Julie Hamos to reverse the award of insurance contracts.
The company is also asking the court to declare that the denial of Health Alliance's protest — filed after its bids were rejected — was in error and illegal — and order the state's chief procurement officer, Matt Brown, to uphold Health Alliance's protest.
Health Alliance is also seeking an action to compel Hamos from continuing on a path of expanding self-insurance for state employees and retirees over the wishes of a commission of the Legislature. Both managed care plans being offered to state employees in East Central Illinois, Health Link and PersonalCare, are self-funded Open Access Plans.
Healthcare and Family Services spokesman Mike Claffey said the agency is confident it followed the state procurement code “to the T” and that was verified by the Executive Ethics Commission.
“We would also note that the plaintiff in the legal action had an opportunity to object to the RFP (request for proposals) at the beginning of the process, and chose not do so. Now, after losing the award and after the denial of their protest, they have turned to the courts.”
What does this mean to state employees scrambling to enroll in health plans?
Claffey says continue enrolling, and the deadline remains June 17.
MoreHA has done everything right and legally, the state has not. The IDHFS does not care about what happens to us in downstate Illinois, it's obvious. A BCBS plan that ONLY covers the Chicago area!? COME ON! REALLY?!?! Their other plans to choose from are confusing and nothing like what we have been getting through HA. The new dental plan is a joke! Who can afford to pay up front these days! The state owes HA 200 million dollars!!!! Do we really think that we'll be reimbursed for our dental in our lifetime!? What about the fine print with these plans of theirs that we don't even know about yet that will probably end up costing us more money! Where is the 'savings' Gov. Quinn???! Our family has had HA for over 15 years with absolutely no issues whatsoever! They pay our claims quickly and accurately. We love the care we get at Carle. This is so messed up. I hope HA wins and puts an end to this once and for all. Blago tried to do this years ago and the people spoke out and fought it (and look where Blago is now!)!! Quinn just did it underhandedly this time. Actions show louder than words- Governor Quinn does not care about who this is affecting. He has repeatedly ignored our pleas. 98 votes to keep HA. 15 votes against (ironically were from Chicago). Enough said.
I went to see my allergy immunologist specialist today who was at a loss on advising me howto receive my allergy shots at through Personalcare's Tier 1 services, since Christie does not have an allergy/immunologist specialist. Christie only has ENTs - none of who have received the specialized training in immunotherapy.
The physcians available in Tier 1 through Personalcare are not comparable to the physicians available at Carle through the HMO.
Further, Christie has no Rheumatologists.
I was also told that Christie has no Psychiatrists either. Who will manage the complex medical regimes that require a medical doctor to adjust?
I have a complex and rare genetic disorder that most doctors know nothing about. I've been with my current physcian for many years. She only has 3 patients including myself who also have this disorder. Most doctors have no experience or working knowledge of how to manage this illness.
Personalcare has told me I have choice. I can stay with my current physcian at Carle who knows me and knows my illness. But, where is the choice if I have to pay so much more to continue with my Carle doctor and cannot afford the $300 deductible, the $700 out-of-pocket annual, in addition to 20% of all other charges, in addition to co-payments and co-insurances that do not count toward one's annual out-of-pocket maximums
It amounts to less care for more money.
And does anyone realize that the monthly premium for Teacher Retirement System dependents has been running near $740/month for an HMO? I have yet to hear of anyone who pays that much in monthly health-care premiums although I'm sure they must be out there.
Someone with the state made a comment in the newspaper to the effect that the fears of those losing Health Alliance are misplaced.
I think this was an extremely insensitive and ignorant remark. Personalcare does not offer the specialists that Health Alliance offers at HMO prices. No allergy specialist, no rheumatologists, no psychiatrists? What do you imagine is the 20% cost for a visit to a Tier 2 psychiatrist at Carle?
I guess one could say the fears of those losing Tier 1 Health Alliance doctors is misplaced if one had unlimited funds to pay the many extra costs for a Tier 2 Carle doctor or one did not suffer from a complex chronic condition that requires continuity of care from a knowlegeable physician who is board certified in the required field. This is not a good country to become sick in, especially not chronically ill. And programs for the disabled, elderly and poor are on the budget chopping block! We are the only industrial nation without some type of universal health care. Guess we sickies need to pull ourselves up from our bootstraps!
I was covered under Personal Care when I underwent treatments for breast cancer in 2003. I had to have my chemotherapy at Christie, my radiation treatments at Provena, and I had to go all the way to Springfield for reconstructive surgery. If my insurance plan had been through Carle, I would have had access to 'in network' doctors all in one place. I was pretty young (35) at the time of my diagnosis, and I still had enough youth and energy to cope. I believe it would be considerably harder on elderly retirees to have to navigate their way through the system. My father is a retired state employee, a brittle diabetic, and he has an endocrinologist at Carle who understands his medical needs.
In terms of a bigger picture, it's situations like these which illustrate how privatized medicine and insurance are allowed to call the shots in the area of quality and affordable health care. Companies like Blue Cross/Blue Shield, Health Alliance, and Personal Care are corporations, and we are now seeing the consequences of allowing these entities to engage in bidding wars which puts lives at stake. Seems to me this mess is another argument for more comprehensive health care reform.
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