Aetna Better Health is terminating its partnership with University of Illinois Hospital & Health Sciences System, a move that could force some Medicaid patients covered by the plan to find new specialists.
article By ALLY MAROTTI for CRAIN'S Chicago | Oct 15, 2015
U of I Health has had a contract with Hartford, Conn.-based Aetna to accept the plan since 2011, said Kevin Dorsey, executive director of managed care at U of I Health. The Aetna Better Health plan is provided through the insurer for disabled adults or adults over age 65 in the Illinois Integrated Care Program who qualify for Medicaid but not Medicare.
U of I Health, on Chicago's Near West Side, includes University of Illinois Hospital, Children's Hospital University of Illinois, an outpatient care center and 13 federally qualified health centers in Chicago.
REIMBURSEMENT FIGHT
The Aetna plan covers about 1,800 patients who receive primary and specialized care through U of I Health, as well as another nearly 4,000 that are referred to specialists there by a primary care physician at another one of the plan's partners, Dorsey said.
Aetna Better Health moved to terminate the partnership because U of I Health would not agree to a request to lower the reimbursement terms.
“Those reimbursement terms were outside of what we could agree to,” Dorsey said.
Although talks between the insurer and health system continue, U of I Health sent letters to its patients enrolled in the plan, informing them that they no longer will be able to receive care at any of the health system's institutions as of Nov. 1. Crain's obtained a copy of the letter (read it below).
PATIENTS WORRIED
Concern is spreading rapidly throughout the disability community, as some families scramble to find new specialists under that looming deadline.
Shirley A. Perez, a program director at disability program provider and advocacy organization Arc of Illinois, belongs to one of those families. Her 39-year-old daughter is enrolled in the plan and sees a specialist at U of I Health for a seizure disorder.
Perez is worried a change in care could trigger complications with her daughter's disorder. She said she has received an onslaught of emails and calls from families with similar concerns.
“If this is detrimental to me and I'm a professional used to working with the managed care companies, what in the world are other families going through?” Perez said.
Coverage likely will continue for some patients under certain exemptions that are still being discussed, Dorsey said.
SWITCHING SPECIALISTS
article By ALLY MAROTTI for CRAIN'S Chicago | Oct 15, 2015
U of I Health has had a contract with Hartford, Conn.-based Aetna to accept the plan since 2011, said Kevin Dorsey, executive director of managed care at U of I Health. The Aetna Better Health plan is provided through the insurer for disabled adults or adults over age 65 in the Illinois Integrated Care Program who qualify for Medicaid but not Medicare.
U of I Health, on Chicago's Near West Side, includes University of Illinois Hospital, Children's Hospital University of Illinois, an outpatient care center and 13 federally qualified health centers in Chicago.
REIMBURSEMENT FIGHT
The Aetna plan covers about 1,800 patients who receive primary and specialized care through U of I Health, as well as another nearly 4,000 that are referred to specialists there by a primary care physician at another one of the plan's partners, Dorsey said.
Aetna Better Health moved to terminate the partnership because U of I Health would not agree to a request to lower the reimbursement terms.
“Those reimbursement terms were outside of what we could agree to,” Dorsey said.
Although talks between the insurer and health system continue, U of I Health sent letters to its patients enrolled in the plan, informing them that they no longer will be able to receive care at any of the health system's institutions as of Nov. 1. Crain's obtained a copy of the letter (read it below).
PATIENTS WORRIED
Concern is spreading rapidly throughout the disability community, as some families scramble to find new specialists under that looming deadline.
Shirley A. Perez, a program director at disability program provider and advocacy organization Arc of Illinois, belongs to one of those families. Her 39-year-old daughter is enrolled in the plan and sees a specialist at U of I Health for a seizure disorder.
Perez is worried a change in care could trigger complications with her daughter's disorder. She said she has received an onslaught of emails and calls from families with similar concerns.
“If this is detrimental to me and I'm a professional used to working with the managed care companies, what in the world are other families going through?” Perez said.
Coverage likely will continue for some patients under certain exemptions that are still being discussed, Dorsey said.
SWITCHING SPECIALISTS
Otherwise, patients wishing to remain with their U of I Health specialist likely will have to find a new specialist in Aetna Better Health's network or find a new managed care entity with U of I Health in its network.
Those who want to find another managed care provider will have to wait until their open enrollment period rolls around, unless there is some exemption worked out. A representative of the Illinois Department of Healthcare and Family Services said enrollment is open to individuals for 60 days annually depending on when they signed up for their plan.
Aetna and U of I Health say they have both committed to making sure patients find coverage. A spokesman from Aetna said in a statement said the insurer still is in negotiations with U of I Health.
“Should we not be able to reach agreement, beneficiaries will continue to receive care through Aetna Better Health's network, which is one of the largest Medicaid networks in the Chicago area,” the statement said.
The spokesman declined to answer any further questions.
The continued talks and promises of a smooth transition seemingly are not helping to allay concerns. Dorsey said these types of termination arrangements are rare. He has only seen it three or four times in his 12 years on the job, he said, and even then, something was worked out at the last minute.
Michael Gelder, a senior health policy adviser for former Gov. Pat Quinn, said the move challenges the whole basis of Illinois' Integrated Care Program.
“The intent of this Integrated Care Program was to improve access to care, but more importantly to improve the quality of care that people with disabilities receive,” said Gelder, a health care policy consultant and adjunct professor in the Department of Human Development at the University of Illinois at Chicago.
“University of Illinois is a high-quality provider and a significant provider to people with disabilities, so excluding them . . . is a big problem.”
Those who want to find another managed care provider will have to wait until their open enrollment period rolls around, unless there is some exemption worked out. A representative of the Illinois Department of Healthcare and Family Services said enrollment is open to individuals for 60 days annually depending on when they signed up for their plan.
Aetna and U of I Health say they have both committed to making sure patients find coverage. A spokesman from Aetna said in a statement said the insurer still is in negotiations with U of I Health.
“Should we not be able to reach agreement, beneficiaries will continue to receive care through Aetna Better Health's network, which is one of the largest Medicaid networks in the Chicago area,” the statement said.
The spokesman declined to answer any further questions.
The continued talks and promises of a smooth transition seemingly are not helping to allay concerns. Dorsey said these types of termination arrangements are rare. He has only seen it three or four times in his 12 years on the job, he said, and even then, something was worked out at the last minute.
Michael Gelder, a senior health policy adviser for former Gov. Pat Quinn, said the move challenges the whole basis of Illinois' Integrated Care Program.
“The intent of this Integrated Care Program was to improve access to care, but more importantly to improve the quality of care that people with disabilities receive,” said Gelder, a health care policy consultant and adjunct professor in the Department of Human Development at the University of Illinois at Chicago.
“University of Illinois is a high-quality provider and a significant provider to people with disabilities, so excluding them . . . is a big problem.”
http://www.chicagobusiness.com/article/20151015/NEWS03/151019879/these-medicaid-patients-may-need-to-find-new-specialists?utm_source=NEWS03&utm_medium=rss&utm_campaign=chicagobusiness
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