Not as advertised: Taxpayers, government workers spend millions on ‘depleted’ insurance plan

CHAMPAIGN, Ill. (WCIA) – A multi-billion welfare company is reaping millions in Illinois tax dollars to run a state-run health insurance plan for retired state workers.

Almost seven months after the plan was reduced by the end of the contract with the main health organization in Champaign and surrounding areas, Aetna has made the fewest possible steps to fill the gap in primary care, leaving the elderly without a regular routine and good health. be careful to delay appointments with doctors as they try to clear a long list of providers who are often not genuine or not.

The January split between Aetna Medicare and provider Carle Health in east central Illinois — which took several Christie Clinic doctors with it — affected at least several hundred patients, many of whom had spent years working in the state, including various positions at the University. of Illinois.

Russ Jacobson, 71, worked for the Illinois Geological Survey for 34 years.

“Aetna, you know they’re supposed to be Medicare, but they’re sitting at the top controlling all the access,” he said in an interview at his home in Urbana.

Aetna’s parent company, CVS Health, reported a profit of $2.3 billion in the first quarter of the year, an increase from this time in 2021. Aetna reaps about $100 million a year from Illinois taxpayers through the Health Insurance Reserve Fund above on federal funds. , all the while holding cards if these patients have a doctor to see.

Health insurance has two main functions, according to Champaign County Health Care Consumers CEO Claudia Lenhoff: Providing access to care and making that care affordable.

“The federal government considers an area unserved, among other things, if providers are more than ten miles away,” Lenhoff, a longtime expert on consumer health issues, explained.

Aetna continues to advertise its Medicare HMO network of more than 130 primary care providers within ten miles of patients in Champaign-Urbana. Most of them are Christie Clinic doctors, and several patients revealed in a months-long survey that they no longer see the clinic’s providers as an option because they don’t cover hospital care in the metro area on Aetna Medicare plans.

Without Christie, and after removing many other providers who were too far away, did not do primary care, or were not available, the press determined that 17 of the approximately 130 providers appeared to be real, accessible options. Eight of the 17 were physicians, the others were physician assistants or nurse practitioners, which means Aetna added two physicians since the April report revealed six physicians were on the list of 168 at the time. The insurer foreclosed on the vacant Target 3 doctor’s office that was said to be owned by a retired doctor.

“It’s not fair to them, they have acted according to the law, they worked for the government, they get a pension,” said Lenhoff after hearing the patients’ complaints.

“And now, because of contract issues that are out of their control, their health care is being disrupted and their lives are being disrupted.”

Eight doctors seem to be enough in metro Champaign to meet the federal network requirements for Medicare Advantage plans, managed by the US Centers for Medicare & Medicaid Services, at least if you consider the 559 Aetna Medicare patients registered in the state as a complete number. of beneficiaries. Aetna would not disclose the total number of customers enrolled, but at least several patients outside the state plan called the WCIA with concerns.

“There’s a lot of anxiety and fear, confusion,” Lenhoff continued. “… Into the lives of Aetna members, who didn’t know this was coming.”

The cost of that confusion isn’t just wasted hours on the phone and choosing a book full of mistakes. In the long run, it’s the health of the community.

Patients, like Jacobson, stop doing routine, but time is necessary. Usually, she sees her general practitioner every six months, “Because I have high blood pressure and I take medication, they want to check my kidneys and liver and make sure nothing is affected by the medication.”

He canceled that preventive care out of fear of the cost that would come with an offline check, and didn’t do it again months later.

“The way it’s been with them, to get back to that time would be difficult, and I didn’t do it,” Jacobson said.

He thought that the bi-annual meeting is now over a year.

“There’s no reason it has to be this way,” Lenhoff concluded at the end of the interview.

“We live in a community that is the Champaign County Hospital and several surrounding counties.”

About a dozen Aetna patients surveyed throughout the survey felt like they were “not getting the whole story” from their insurer. The direct quote comes from Melody McDaniel who worked at the University of Illinois for 30 years.

“It would have been better if someone had told us, ‘This is why.’ Instead of just making you hang out here, trying to estimate again, and we’re trying to read between the lines,” he said.

Aetna did not respond to repeated questions about its role in selling the policy and the misleading book or about its role in the break-up with Carle.

Carle Health Public Relations Manager Brittany Simon did not elaborate beyond a statement from March that Aetna Medicare did not include universal health coverage and wanted to say “uniform coverage across the state.”

Simon confirmed negotiations with Aetna have ended.

“There are no ongoing discussions with Aetna at this time,” the response read.

The 3rd annual report on health insurance disputes shows disagreements over the reimbursement rates insurers want to pay doctors. Neither company would comment on this topic when asked directly.

The press also filed several Freedom of Information Act (FOIA) requests with the US Centers for Medicare & Medicaid Services to, among other things, obtain recent reviews of the network’s adequacy of Aetna’s physician directory. The federal agency has extended the deadline for April applications.

“If you tell people, ‘These are the ones giving you,’ then they have to be your supporters, or you can change,” Republican Senator Chapin Rose of Mahomet responded. He, too, has heard about the problems found from “multiple areas”.

“I don’t know much about health care, but I am a lawyer. When you have, you know, a contract, and you pay your contract, you have the right to the benefits that you were promised. And these people are paying their benefits, but they are not getting them.”