[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 16:33:54 CDT 2011

*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? *
*Ya'aqov

*
*On Tue, Apr 26, 2011 at 4:27 PM, Stuart Levy <slevy at ncsa.illinois.edu>wrote:
*
>
> *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
> > >
> > >
> *
>
*

-- 
ya'aqovZISO | yaaqovz at gmail.com | 856 217 3456

*
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