Cigna leaves some Carle patients in lurch

Cigna leaves some Carle patients in lurch

Insurer ended HealthLink deal, so some services out of network

URBANA — One of the first calls of the new year Chris Scherer got was from his doctor's office advising him that his upcoming visit wouldn't be covered by insurance.

Would he like to cancel the appointment he has lined up for Monday, the Urbana resident was asked?

Scherer, a 71-year-old Carle patient, is covered by Cigna under the health plan of his wife, Jane, who works for the University of Illinois Extension.

Cigna administers the state's Quality Care health plan for state employees, but Carle patients with Cigna insurance weren't being covered under a contract between Carle and Cigna.

Since 2006, Cigna had a direct agreement with HealthLink, which allowed Cigna members access to HealthLink's broad network of participating physicians and hospitals (including Carle) for care, according to HealthLink spokeswoman Deborah Wiethop. Cigna opted to terminate that agreement as of Jan. 1, she said.

Carle spokeswoman Jennifer Hendricks said Carle Foundation Hospital continues to be in-network for Cigna members, and Carle is working to enter into a direct contract with Cigna itself for Carle Physician Group and Carle Hoopeston that could provide in-network coverage for Cigna members retroactive to Jan. 1.

"We can't guarantee in-network coverage for Carle Physician Group and Carle Hoopeston at this point, since the administrative details of the contract have not been finalized," Hendricks said in an email Friday. "So we're being proactive and calling affected patients scheduled to be seen in the next week to let them know they may be responsible for higher out-of-pocket expenses since Carle Physician Group and Carle Hoopeston aren't currently in-network with Cigna."

Carle is also advising patients receiving maternity, chemotherapy, dialysis or other ongoing care to complete Cigna's transition of care form to request approval for 90-day coverage at in-network rates, Hendricks said. Those with questions should call the toll-free number on their insurance card.

Wiethop said the contract termination with HealthLink affects all Cigna members, but affected state of Illinois employees approaching open enrollment May 1 could gain access to Carle though a HealthLink plan.

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