<font class="Apple-style-span" face="georgia, serif"><i>Thank you Stuart and John. Looks like my little question sparked valuable info: how do we now propagate this to the people/families who need to change their plans? </i></font><div>
<font class="Apple-style-span" face="georgia, serif"><i><font class="Apple-style-span" color="#6666CC">Ya'aqov</font><br><br></i></font><div class="gmail_quote"><font class="Apple-style-span" face="georgia, serif" color="#666666"><i>On Tue, Apr 26, 2011 at 4:27 PM, Stuart Levy <span dir="ltr"><<a href="mailto:slevy@ncsa.illinois.edu">slevy@ncsa.illinois.edu</a>></span> wrote:<br>
</i></font><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex;"><div class="im"><font class="Apple-style-span" face="georgia, serif" color="#666666"><i>On Mon, Apr 25, 2011 at 04:13:15PM -0500, John W. wrote:<br>
> Stuart, I'm reasonably certain that Blue Cross Blue Shield has PPO<br>
> agreements or arrangements with Carle, Christie Clinic, and Provena<br>
> Hospital. Is a PPO not as good, in your view, as an HMO? Are you including<br>
> a PPO under your heading of "conventional insurance"?<br>
><br>
> John Wason<br>
<br>
</i></font></div><font class="Apple-style-span" face="georgia, serif" color="#666666"><i>(following up with this correction to peace-discuss, for my peace of mind, at least)<br>
<br>
John,<br>
<br>
It's true, I was thinking of a PPO as acting like conventional insurance,<br>
but hadn't looked into the details in this case. After a bit of<br>
digging, you're right -- *if* they know what to do, PersonalCare HMO<br>
(Provena/Christie) users will have to switch away from an HMO, but they<br>
can still get coverage that looks very similar to what they have now,<br>
from (it seems) the same providers.<br>
<br>
<br>
The new plan for State/University employees includes HealthLink OAP<br>
(Open Access Plan). This isn't formally an HMO -- it has multiple<br>
tiers of providers, with different levels of coverage depending on<br>
which ones you use. However, the OAP Tier I coverage looks to be<br>
the same as HMO coverage, judging from last year's State benefits booklet<br>
plus the HealthLink web site for IL employees. And, Provena Hospital<br>
and at least many (maybe all?) of the Christie doctors<br>
are included in Healthlink OAP Tier I.<br>
<br>
That would explain why Provena isn't protesting the State change,<br>
which might well drive some Health Alliance / Carle users into their fold.<br>
<br>
The effect: people currently on PersonalCare HMO (Covenant &c)<br>
must know to switch to Healthlink OAP during next month's<br>
benefit-selection period. (If they don't, they'll be dumped into<br>
the Quality Care conventional-insurance plan and be stuck with it<br>
for the full year.) But if they do make that switch, then they'll<br>
be on a plan with a different name that is similar in cost<br>
and features to what they have now. And, they won't have to use<br>
Blue Cross/Blue Shield (which has a bad reputation).<br>
<br>
(Those of us using HealthAlliance HMO aren't so lucky.)<br>
<br>
References:<br>
<a href="http://www.healthlink.com/soi_learn_more.asp" target="_blank">http://www.healthlink.com/soi_learn_more.asp</a><br>
(see the two "State of Illinois Members" links<br>
under "Benefit Overviews" and "Summary Plan Descriptions")<br>
(and, I did a provider search on HealthLink OAP too)<br>
<br>
<a href="https://nessie.uihr.uillinois.edu/pdf/benefits/BC_Booklet.pdf" target="_blank">https://nessie.uihr.uillinois.edu/pdf/benefits/BC_Booklet.pdf</a><br>
UofI's description of (medical & other) plans, costs, and their benefits<br>
</i></font><div><div></div><div class="h5"><font class="Apple-style-span" face="georgia, serif" color="#666666"><i><br>
<br>
> On Mon, Apr 25, 2011 at 3:27 PM, Stuart Levy <<a href="mailto:slevy@ncsa.illinois.edu">slevy@ncsa.illinois.edu</a>>wrote:<br>
><br>
> On Mon, Apr 25, 2011 at 02:30:25PM -0500, Ya'aqov Ziso wrote:<br>
> > > *<br>
> > > ><br>
> > > > ... since BCBS has no arrangements with any local providers ....<br>
> > ><br>
> > > ===============<br>
> > > I have spent over an hour with a Carle Express administrator who made<br>
> > > several phone calls and then assured me that Carle does NOT but Christie<br>
> > > DOES have arrangements with BCBS.<br>
> > > Stuart, can you indicate the source of your information?<br>
> > > Ya'aqov<br>
> ><br>
> > [Setting followups to the "peace-discuss" list, but I'll post this here<br>
> > in hope it's of interest to enough people...]<br>
> ><br>
> > It's from Blue Cross Blue Shield of IL's web site (below), which offers a<br>
> > "search for provider" by city or zip code. I've tried both of the HMOs<br>
> > which the the State proposes to offer -- HMO Illinois and<br>
> > Blue Advantage HMO -- and looked for general-practice doctors and<br>
> > (sometimes)<br>
> > for hospitals and "HMO Clinics". All searches starting from Champaign,<br>
> > regardless of "distance willing to travel", yield a message that<br>
> > "the zip code entered is not within the HMO service area. Members must<br>
> > live<br>
> > within the HMO service area in order to receive benefits."<br>
> ><br>
> > Possible explanations for the response you got:<br>
> ><br>
> > - Christie may have non-HMO arrangements with BCBS.<br>
> ><br>
> > I searched specifically for HMO offerings, which are what<br>
> > the state proposes to change, and which are the most economical<br>
> > plans for people who can accept the limitations of HMO coverage.<br>
> ><br>
> > Non-HMO (e.g. conventional insurance) plans will definitely still<br>
> > be available. Even if the state plan goes ahead, health care with<br>
> > local providers will still have coverage, but under things like<br>
> > Quality Care Health Plan -- conventional insurance -- which will<br>
> > cost more and (I think but haven't checked) cover less. They're<br>
> > also more prone to finger-pointing between insurer and provider.<br>
> ><br>
> > - Christie may have *future* HMO arrangements with BCBS, which aren't<br>
> > listed on BCBS's web site because they aren't yet available.<br>
> ><br>
> > - BCBS's web site,<br>
> > <a href="http://www.bcbsil.com/providers/" target="_blank">http://www.bcbsil.com/providers/</a><br>
> > may not match what they offer. But you'd think they'd want to make it<br>
> > reflect their coverage well so that people would buy their insurance.<br>
> ><br>
> ><br>
> > > *On Mon, Apr 25, 2011 at 2:03 PM, Karen Medina <<a href="mailto:kmedina67@gmail.com">kmedina67@gmail.com</a>><br>
> > wrote:<br>
> > > *<br>
> > > ><br>
> > > > *Action item of the week: Call state legislators about Illinois<br>
> > > > limiting the health care options for employees of Illinois.<br>
> > > ><br>
> > > ><br>
> > > > Conrad Wetzel: "Please remind people about the Health Alliance issue."<br>
> > > ><br>
> > > > Catherine Gray: "If you're as enraged as I am about the Health<br>
> > > > alliance thing, please call our illustrious Gov. Quinn and sign Mike<br>
> > > > Frerichs’s petition about it. As is often the case, the more of us<br>
> > > > that protest, the better."<br>
> > > ><br>
> > > > Stuart Levy: "This affects health coverage for anyone who works for<br>
> > > > the State (including UofI). The State proposes to drop all the HMOs<br>
> > > > that serve east-central IL (Health Alliance, Humana, PersonalCare), in<br>
> > > > favor of Blue Cross/Blue Shield statewide, as I understand it. If it<br>
> > > > happens as planned, then as of July, any HMO-covered employees in this<br>
> > > > area would either need to switch to costlier non-HMO insurance, or<br>
> > > > find new doctors in distant parts of the state, (since BCBS has no<br>
> > > > arrangements with any local providers). Health Alliance has filed a<br>
> > > > formal protest, and there's been a fair public uproar, including a<br>
> > > > hearing on Wednesday in Springfield chaired by Naomi Jakobsson."<br>
> > > > ====<br>
> > > > Governor Pat Quinn's phone <a href="tel:217-782-0244" value="+12177820244">217-782-0244</a><br>
> > > > ====<br>
> > > > Senator Frerichs sent a letter to Governor Pat Quinn and Julie Hamos,<br>
> > > > Director of the Department of Health and Family Services, urging them<br>
> > > > to reverse their decision to end the state's contract with Health<br>
> > > > Alliance.<br>
> > > ><br>
> > > > Senator Frerichs also launched a petition on his website where those<br>
> > > > who stand with him in support of Health Alliance can show their<br>
> > > > support.<br>
> > > > <a href="http://www.mikefrerichs.com/" target="_blank">http://www.mikefrerichs.com/</a><br>
> > > ><br>
> > > > One paragraph from Frerichs' letter: "I understand the Governor's<br>
> > > > intent behind the suggested change is to cut costs, but I fear that<br>
> > > > ending the state's contract with Health Alliance will actually have<br>
> > > > the opposite effect. Without a contract with Health Alliance, members<br>
> > > > of the state's group insurance plan in downstate Illinois are left<br>
> > > > without an affordable, accessible HMO option. Over the long term, I'm<br>
> > > > convinced a continued contract with Health Alliance will be more<br>
> > > > affordable for the state."<br>
> > > > -<br>
> > > ><br>
> > <a href="http://www.mikefrerichs.com/images/stories/Senator%20Frerichs%20Health%20Alliance%20Letter.pdf" target="_blank">http://www.mikefrerichs.com/images/stories/Senator%20Frerichs%20Health%20Alliance%20Letter.pdf</a><br>
> ><br>
> > > --<br>
> > > ya'aqovZISO | <a href="mailto:yaaqovz@gmail.com">yaaqovz@gmail.com</a> | <a href="tel:856%20217%203456" value="+18562173456">856 217 3456</a><br>
> ><br>
> ><br>
</i></font></div></div></blockquote></div><font class="Apple-style-span" face="georgia, serif" color="#666666"><i><br><br clear="all"><br>-- <br>ya'aqov<b>ZISO</b> | <a href="mailto:yaaqovz@gmail.com" target="_blank">yaaqovz@gmail.com</a> | 856 217 3456<br>
<br></i></font><br>
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