OSF's Urbana, Danville hospitals out of network for many state employees

OSF's Urbana, Danville hospitals out of network for many state employees

CHAMPAIGN — The week-old change of ownership for former Presence Health hospitals in Urbana and Danville is affecting more than Blue Cross Blue Shield members in East Central Illinois.

The former Presence Covenant and Presence United Samaritans medical centers — renamed OSF Heart of Mary and OSF Sacred Heart medical centers — also became out-of-network hospitals on Feb. 1 for state employees in four out of the five health plans that were available in this part of the state.

That wasn't great to hear for Nancy Holm of Champaign. She's a University of Illinois employee enrolled in the state's HealthLink Open Access Plan, which isn't under contract with OSF HealthCare for the Urbana and Danville hospitals.

Her husband, Tom, is a state retiree covered by an Aetna/Coventry Medicare Advantra plan, she said. Along with BlueCross Blue Shield, Aetna/Coventry is among the insurance carriers OSF is still negotiating with for the two hospitals.

Should she need to go to a hospital, Nancy Holm said, her HealthLink plan would provide benefits at Carle Foundation Hospital — but only at a "tier II" level, meaning her out-of-pocket costs would be higher.

She and her husband were aware the change of ownership was coming up, she said, but didn't know the new owner wouldn't take their insurance. Nor did she get any warning about a change in benefits from HealthLink, Holm said.

"Wouldn't you think they'd have sent us a letter?" she asked.

Holm said she talked to someone on staff at the state's Department of Central Management Services and she was advised she could go to Clinton for full hospital benefits. Holm said she, in turn, asked about the possibility of state employees and retirees affected by the hospital change getting a chance to choose a new health plan for the current year.

"To me, this seems like a change of benefits right in the middle of the benefits year," she said.

OSF HealthCare recently signed a contract with Health Alliance Medical Plans covering the OSF hospitals in Urbana and Danville. State employees covered under the Aetna HMO, Aetna Open Access Plan, HealthLink OAP and the Quality Care plan (administered by Aetna) wishing to use those hospitals appear to be out of luck.

OSF HealthCare spokeswoman Shelli Dankoff said OSF has completed contracts with insurers for a number of commercial, Medicare and Medicaid plans for the Urbana and Danville hospitals, but contract negotiations are still underway with Blue Cross Blue Shield, Aetna/Coventry and HealthLink.

"OSF HealthCare remains hopeful of reaching a positive resolution so we are able to continue to meet the needs of those we've been called to serve," said a response from the Peoria-based system.

Meanwhile, OSF said it is offering a "benefits match" for those patients who are under physician's orders for services such as chemotherapy or physical therapy being carried out at the two hospitals.

"This means that even though the facility is currently out-of-network in the eyes of any payers we are negotiating with, OSF will make the appropriate adjustments so that the patient is only responsible for out-of-pocket costs that they would incur at an in-network facility," the health system said. "OSF HealthCare is making these adjustments only until an agreement has been completed with payers we are negotiating with, and only for patients with a prior active treatment plan that began prior to Feb. 1."

Illinois Central Management Services spokesman Mike Deering said emergency room coverage remains at in-network levels, and for other hospital care needed locally by state employees, Carle Foundation Hospital is in network for Aetna and covered at the tier II level for HealthLink.

"Please note that should a member of any health plan be undergoing treatment at either (former) Presence hospital, their health plan is obligated to provide a 'continuity of care' plan that bridges the individual with full coverage through the duration of their medical care," he said.

Deering said this situation isn't one that would qualify state employees for a change of health plans applying to the current benefits year, and he advised state group plan members to call their health plans to find other hospitals in their area.

"This is not considered a qualifying change in member status," he said. "If a hospital leaves a health plan's network, the member needs to identify another hospital with the plan's network for full benefits coverage. The state of Illinois as an employer, however, does not have a say in provider network contractual negotiations conducted by participating health insurance carriers."

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