CHAMPAIGN COUNTY, Ill. (WCIA) – The physician network for a number of in-state retirees living in Champaign County has been cut for the second time this year.

The Carle Foundation Hospital in Urbana severed ties with Aetna Medicare plans less than three months ago and effective May 1, Aetna intends to remove several providers from the Christie Clinic in Champaign, Urbana and Mahomet from his network because of their relationship with Carle.

Vicki Good — a retired teacher from central Illinois — signed up for Aetna’s Medicare Advantage HMO plan when she moved to Champaign. It is one of two health insurance options for Champaign County state retirees enrolled in Medicare. The other is United Healthcare PPO.

“When it was open enrollment, nobody said, ‘Oh, by the way, we’re going to take a lot of doctors out of the network,'” Good said.

Her primary care physician is at the Christie Clinic, until her insurance no longer covers the costs on May 1. Good was first informed of the network change in a March 1 letter from Aetna.

A phone number for an alternate doctor was included, but when she called, “and I said, ‘Is he accepting new patients?'” the receptionist on the other end of the line said, “No” and “Not only that, he is [also] will be off-grid from May 1.

The domino effect began when Carle Foundation Hospital terminated its contract with Aetna Medicare, excluding all of its health care providers from the network for these patients effective January 1, 2022. Carle, Aetna or Christie Clinic would explain why providers of clinics are expelled from the network four months later.

Christie Clinic Chief Financial Officer Anni McClellan said “fewer than 17 of our 179” primary care physicians and specialists will no longer be available at network rates for Aetna Medicare patients due to their affiliation with Carle Hospital. . It is common practice for physicians in clinics without emergency rooms to obtain admitting privileges from local hospitals.

We are told that the “less than 17” number is an estimate of the number of suppliers that have been notified so far by Aetna.

“I really feel like I don’t know what to do about health care,” Good said. “My question, you know, for Aetna is, what am I supposed to do during this transition period? You know, I’m very lucky. I am a very healthy person in general. But what should I do if I have a heart attack?

The Illinois Department of Central Management Services (CMS) administers the state’s retiree health insurance plans.
Cathy Kwiatkowski, associate director of communications, said doctors had “the opportunity and the time” to gain admitting privileges at other hospitals. She said in a statement Wednesday, “Physicians who are no longer part of the network have not exercised this opportunity.”

“I just feel like they took advantage of us.”

Vicki Good, retired teacher

559 Champaign County retirees are enrolled in the Aetna Medicare plan, according to Kwiatkowski.

The state was “unable to provide an estimate of the number of limbs likely to be affected.” Kwiatkowski said CMS does not collect this data. Carle Foundation Hospital forwarded the question to Aetna, which did not respond to requests for comment on Wednesday.

Courtney Luth, regional director of medical practice at OSF Healthcare in Urbana, says Aetna Medicare patients represent about 11% of all of their patients.

The hospital has started to see an influx of new patients since January, according to Luth, which she says their providers are equipped to handle.

“So far we have been able to, you know, provide the service that they have asked us to provide,” she added when asked if they had access to all the types of specialists requested. .

For now, Vicki Good said she is waiting to see if a renegotiation is in the cards for her insurer and her affiliate doctor Carle.

“And I just refuse to go through their entire directory calling doctor after doctor after doctor trying to figure out who is really going to be a provider in the network,” she said. “Their bottom line is that they want to make a profit for their business… But it seems like they’re taking more and more choices away from us.”

McClellan, Christie Clinic’s chief financial officer, said they were working on “additional hospital relationships” that would network for Aetna patients.

READ MCCLELLAN’S FULL STATEMENT:

At this time (3/22/22), less than 17 of our 179 providers (Primary Care and Specialists) at Christie Clinic have received notification from Aetna that they are now terminated and out of network for plans. Aetna Medicare Advantage (PPO and HMO) effective May 1, 2022. These Christie Clinic providers are now out of network due to their hospital relationship to the Carle Foundation and which is no longer an Aetna network hospital. Although Christie Clinic has not terminated its contract with Aetna Medicare Advantage, we expect other providers to be designated as out-of-network. Patients can continue to see Christie Clinic providers even if their provider is now an out-of-network Aetna Medicare Advantage provider, but they may incur higher co-pays or have higher out-of-pocket charges than in-network. Christie Clinic and these providers have been advised that the termination of their participation in the plan is due to Carle Foundation Hospital’s participation in Aetna’s Medicare Advantage products ending December 31, 2021. Christie Clinic is working on additional hospital relationships that are networked for Aetna for certain providers, where applicable. to improve coverage. Aetna patients should contact Aetna to better understand their coverage.

READ THE FULL STATEMENT FROM THE CARLE FOUNDATION HOSPITAL:

What I can share is that the Carle System works closely with insurance plans to ensure robust coverage options are available. Aetna’s previous Medicare Advantage HMOs and PPOs did not include full access to the Carle system, particularly the Carle Group of Physicians, and our goal is to align offerings across the region, so this particular plan has was discontinued at Urbana Hospital on January 1, 2022. However, we will continue to accept a range of Aetna plans at Carle Foundation Hospital and throughout the region. You can find a list of active relationships with insurance providers, by location, on Carle.org.