[Peace-discuss] periodic call to action: call about Illinois limiting the health care options to BlueCrossBlueShield and putting downstate employees in a bad possition

Tue Apr 26 16:27:03 CDT 2011

On Mon, Apr 25, 2011 at 04:13:15PM -0500, John W. wrote:
> Stuart, I'm reasonably certain that Blue Cross Blue Shield has PPO
> agreements or arrangements with Carle, Christie Clinic, and Provena
> Hospital.  Is a PPO not as good, in your view, as an HMO?  Are you including
> a PPO under your heading of "conventional insurance"?
> 
> John Wason

(following up with this correction to peace-discuss, for my peace of mind, at least)

John,

It's true, I was thinking of a PPO as acting like conventional insurance,
but hadn't looked into the details in this case.  After a bit of
digging, you're right -- *if* they know what to do, PersonalCare HMO
(Provena/Christie) users will have to switch away from an HMO, but they
can still get coverage that looks very similar to what they have now,
from (it seems) the same providers.

The new plan for State/University employees includes HealthLink OAP
(Open Access Plan).  This isn't formally an HMO -- it has multiple
tiers of providers, with different levels of coverage depending on
which ones you use.  However, the OAP Tier I coverage looks to be
the same as HMO coverage, judging from last year's State benefits booklet
plus the HealthLink web site for IL employees.   And, Provena Hospital
and at least many (maybe all?) of the Christie doctors
are included in Healthlink OAP Tier I.

That would explain why Provena isn't protesting the State change,
which might well drive some Health Alliance / Carle users into their fold.

The effect: people currently on PersonalCare HMO (Covenant &c)
must know to switch to Healthlink OAP during next month's
benefit-selection period.  (If they don't, they'll be dumped into
the Quality Care conventional-insurance plan and be stuck with it
for the full year.) But if they do make that switch, then they'll
be on a plan with a different name that is similar in cost
and features to what they have now.  And, they won't have to use
Blue Cross/Blue Shield (which has a bad reputation).

(Those of us using HealthAlliance HMO aren't so lucky.)

References:
    http://www.healthlink.com/soi_learn_more.asp
	(see the two "State of Illinois Members" links
	 under "Benefit Overviews" and "Summary Plan Descriptions")
	(and, I did a provider search on HealthLink OAP too)

    https://nessie.uihr.uillinois.edu/pdf/benefits/BC_Booklet.pdf
	UofI's description of (medical & other) plans, costs, and their benefits

> On Mon, Apr 25, 2011 at 3:27 PM, Stuart Levy <slevy at ncsa.illinois.edu>wrote:
> 
> On Mon, Apr 25, 2011 at 02:30:25PM -0500, Ya'aqov Ziso wrote:
> > > *
> > > >
> > > > ... since BCBS has no arrangements with any local providers ....
> > >
> > > ===============
> > > I have spent over an hour with a Carle Express administrator who made
> > > several phone calls and then assured me that Carle does NOT but Christie
> > > DOES have arrangements with BCBS.
> > > Stuart, can you indicate the source of your information?
> > > Ya'aqov
> >
> > [Setting followups to the "peace-discuss" list, but I'll post this here
> > in hope it's of interest to enough people...]
> >
> > It's from Blue Cross Blue Shield of IL's web site (below), which offers a
> > "search for provider" by city or zip code.  I've tried both of the HMOs
> > which the the State proposes to offer -- HMO Illinois and
> > Blue Advantage HMO -- and looked for general-practice doctors and
> > (sometimes)
> > for hospitals and "HMO Clinics".  All searches starting from Champaign,
> > regardless of "distance willing to travel", yield a message that
> > "the zip code entered is not within the HMO service area.  Members must
> > live
> > within the HMO service area in order to receive benefits."
> >
> > Possible explanations for the response you got:
> >
> >  - Christie may have non-HMO arrangements with BCBS.
> >
> >    I searched specifically for HMO offerings, which are what
> >    the state proposes to change, and which are the most economical
> >    plans for people who can accept the limitations of HMO coverage.
> >
> >    Non-HMO (e.g. conventional insurance) plans will definitely still
> >    be available.  Even if the state plan goes ahead, health care with
> >    local providers will still have coverage, but under things like
> >    Quality Care Health Plan -- conventional insurance -- which will
> >    cost more and (I think but haven't checked) cover less.  They're
> >    also more prone to finger-pointing between insurer and provider.
> >
> >  - Christie may have *future* HMO arrangements with BCBS, which aren't
> >    listed on BCBS's web site because they aren't yet available.
> >
> >  - BCBS's web site,
> >      http://www.bcbsil.com/providers/
> >    may not match what they offer.  But you'd think they'd want to make it
> >    reflect their coverage well so that people would buy their insurance.
> >
> >
> > > *On Mon, Apr 25, 2011 at 2:03 PM, Karen Medina <kmedina67 at gmail.com>
> > wrote:
> > > *
> > > >
> > > > *Action item of the week: Call state legislators about Illinois
> > > > limiting the health care options for employees of Illinois.
> > > >
> > > >
> > > > Conrad Wetzel: "Please remind people about the Health Alliance issue."
> > > >
> > > > Catherine Gray: "If you're as enraged as I am about the Health
> > > > alliance thing, please call our illustrious Gov. Quinn and sign Mike
> > > > Frerichs’s petition about it. As is often the case, the more of us
> > > > that protest, the better."
> > > >
> > > > Stuart Levy: "This affects health coverage for anyone who works for
> > > > the State (including UofI). The State proposes to drop all the HMOs
> > > > that serve east-central IL (Health Alliance, Humana, PersonalCare), in
> > > > favor of Blue Cross/Blue Shield statewide, as I understand it. If it
> > > > happens as planned, then as of July, any HMO-covered employees in this
> > > > area would either need to switch to costlier non-HMO insurance, or
> > > > find new doctors in distant parts of the state, (since BCBS has no
> > > > arrangements with any local providers). Health Alliance has filed a
> > > > formal protest, and there's been a fair public uproar, including a
> > > > hearing on Wednesday in Springfield chaired by Naomi Jakobsson."
> > > > ====
> > > > Governor Pat Quinn's phone 217-782-0244
> > > > ====
> > > > Senator Frerichs sent a letter to Governor Pat Quinn and Julie Hamos,
> > > > Director of the Department of Health and Family Services, urging them
> > > > to reverse their decision to end the state's contract with Health
> > > > Alliance.
> > > >
> > > > Senator Frerichs also launched a petition on his website where those
> > > > who stand with him in support of Health Alliance can show their
> > > > support.
> > > > http://www.mikefrerichs.com/
> > > >
> > > > One paragraph from Frerichs' letter: "I understand the Governor's
> > > > intent behind the suggested change is to cut costs, but I fear that
> > > > ending the state's contract with Health Alliance will actually have
> > > > the opposite effect. Without a contract with Health Alliance, members
> > > > of the state's group insurance plan in downstate Illinois are left
> > > > without an affordable, accessible HMO option. Over the long term, I'm
> > > > convinced a continued contract with Health Alliance will be more
> > > > affordable for the state."
> > > > -
> > > >
> > http://www.mikefrerichs.com/images/stories/Senator%20Frerichs%20Health%20Alliance%20Letter.pdf
> >
> > > --
> > > ya'aqovZISO | yaaqovz at gmail.com | 856 217 3456
> >
> >