Some worry about changing insurers - and doctors - during treatment

Some worry about changing insurers - and doctors - during treatment

ST. JOSEPH — Waiting to hear details of new Medicare Advantage plans for state retirees has been tough for Nancy Bishop.

She and her husband, Terry, both 69, are state retirees who have been covered by one of the rejected bidders for a new state contract, Health Alliance Medical Plans. And Terry Bishop is in the midst of cancer treatments at Carle and might have to change doctors.

"It is stressful because you're up in the air," the St. Joseph woman said Wednesday. "You can't make plans."

The time for bidders to protest new Medicare Advantage contracts for state retirees ended at midnight Tuesday without any protests being filed, according to the state's chief procurement office.

Details of new Medicare Advantage plans for retirees weren't available Wednesday because the contracts hadn't yet been signed, according to the state Department of Central Management Services.

The Bishops are among about 6,000 Health Alliance retiree-members who see Carle physicians, and the insurer said those Carle members will need to change doctors if they stay with the state's coverage for those on Medicare.

The state will be supplying Medicare Advantage plans through Humana Health plan, Humana Benefit Plan, Aetna Life Insurance Co. and United Healthcare, but Carle doctors do not have Medicare Advantage contracts with those four insurance providers.

"The state worked to procure the best options for its Medicare retirees and their dependents, ensuring cost-effective coverage while giving retirees the quality and continuity of care that they expect and deserve," said Anjali Julka, a spokeswoman for Central Management Services, in an email to The News-Gazette.

"Please note again that members enrolled in the PPO plan can see any provider."

Julka also said new Medicare Advantage plans for state members will be posted on the state CMS website soon.

Earlier this month, Carle officials said the Urbana-based medical group  does have a PPO contract with United Healthcare, but it doesn’t include Medicare Advantage patients.

“The only contract Carle has for physician services under Medicare Advantage is with Health Alliance. Carle does have a PPO contract for physician services with United, but it specifically excludes Medicare Advantage,” Carle Chief Financial Officer Dennis Hesch said in a written statement.

Retirees on Medicare can also opt out of the state program and buy coverage on their own, but Nancy Bishop said that could be expensive.

Terry Bishop has non-Hodgkin lymphoma, his wife said, and they fear what an interruption in his care at Carle might mean.

"He's done so well with his doctor that we just don't want to change," Nancy Bishop said.

Her own health is fine, though she's got a heart rhythm disorder Carle is looking after, she said.

"I've been going to Carle since my kids were little, so it's right about 40 years," she said.

Bishop says she's retired from the state Department of Children and Family Services and her husband is retired from the University of Illinois, and she's always believed their health coverage through the state has been great.

Now, she said, she feels the state is trying to force retirees out of the system.

Bishop says her husband needs to undergo a minimum of four more months of chemotherapy treatments "if they can get the lymph nodes shrunk down far enough."

But, she also wonders, if they have to change doctors, "how long will it take us to change somewhere? Will that interrupt his treatment, and will that cause it to flare up again?"

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Rocky7 wrote on October 10, 2013 at 11:10 am

Speaking frankly, the state of Illinois has made a complete hash of this health insurance change.  If one read's their latest release

(http://www2.illinois.gov/cms/Employees/benefits/StateEmployee/Pages/MedicareAdvantageInformation.aspx)

it will tell you how unprepared they are.

Nohing has been done (by their own admission) although the state CMS knew this was coming last May.  IL-CMS is only now beginning to train people to handle customer questions, prepare brochures and materials, and write a letter to those in the state plan on Medicare.

Worse still is the fact, according to the 2014 Medicare booklet (p. 76) that Medicare Advantage policy holders are PREVENTED from purchasing a Medicare SUpplement (Medigap) plan of any kind. I called Medicare and confirmd it. Urrently, the state provides that because Medicare pays the rest.

When people refer to Illiois as the 'failed Grecian state of Illinois,' IL-CMS epitomizes exatly that with its lack of foresight and planning plus the thoughlessness and rudeness of its call-center employees.

State retirees deserve a lot better and so do the Illinois taxpayers who pay for this..

Bulldogmojo wrote on October 10, 2013 at 1:10 pm

Just as with pensions these healthcare changes are done without any consideration by the powers that be in Springfield because other people don't have a real existence to them. They are indifferent and not forward thinking beyond their own narrow agendas.

tarichardson46 wrote on October 10, 2013 at 7:10 pm

So these folks worked for 25 years and had a signed union contract that guaranteed this insurance. What happened to that contract? Where is the Union?? Does this mean that all signed contracts are null and void whenever a person no longer feels like honoring it? How is this legal - these people cannot return to work to obtain other insurance...and shouldn't have to! They put their time in and should be given what they were promised!! So the State has already squandered our pension money and now they're taking away health insurance coverage for the retired?? Is there no end to what these criminals are able to get away with!?

airrecon wrote on October 10, 2013 at 8:10 pm

 

Retirees are a soft target.  They have no strong lobby. They have no champions within the hallowed halls where decisions about them are made. They have no ability to strike or engage in work slow-downs to show their displeasure.  They are an easy mark. 

The political animal in this state is a predator, but it is not a particularly courageous one. Given a choice of making a meal of prey that is able to defend itself or one that has limited defensive  attributes, this predator  will always avoid the claws and teeth.

The legislature, the governor and the media vilified the public employee in order to take attention away from the fact that those not-so-wise men in state government exacerbated the pension problem for political gain. Despite the fact that government entities created the problem, they managed to redirect the  blowtorch of taxpayer anger away from themselves and at that soft target.  This is just one more plot turn in a episode of Illinois politics and incompetence in  story that just gets more and more bizarre.

 

yates wrote on October 11, 2013 at 1:10 am

Retirees aren't the only ones that should be worried about their insurance and doctors. My daughter and her husband just got notified that Blue Cross is raising their premiums 100% Jan 1st. All those new democrat voters ain't going to come cheap.

spangwurfelt wrote on October 11, 2013 at 3:10 pm

"Retirees are a soft target.  They have no strong lobby."

Unless you count the all-powerful AARP.

Rocky7 wrote on October 12, 2013 at 6:10 am

Anyone who thinks AARP is an advocacy group for retirees is living in a dream-world, They are an insurance company and that's it.  Their discounts are higher than available via other sources on the Internet and their magazne is more like an "Elderly People's" magazine.  A friend of retirees AARP is not.

Until the IL-CMS provides details, readers are advised one of the Medicare Advantage Plans is linked with AARP according to that insurance provider's website. Will the state require AARP membership to selet that option?  Wouldn't surprise me.