URBANA, Ill. (WCIA) — Carle Health and Aetna Monday struck a deal. Retired state employees enrolled in state-sponsored health benefits will be able to continue to see their Carle doctors at an in-network rate in the new year, according to both companies’ leadership. The news came late on the eve of the first day of open enrollment for those state benefits administered by the Illinois Department of Central Management Services (CMS).
Retirees and their dependents, for the first time, were given just one state-sponsored plan to choose from. For months, they’ve questioned whether the new Aetna Medicare Advantage PPO plan option would mean losing their doctors of decades. Carle is the major provider in central Illinois, and the loss of its 550+ eastern-central Illinois doctors and facilities affected roughly 11,000 retirees enrolled in the Total Retiree Advantage Illinois Medicare Advantage Prescription Drug (TRAIL MAPD) plan.
In a joint press release, Carle and Aetna announced “a tentative agreement.”
“Finalization of this contract will allow Medicare-eligible state retirees to continue to be seen by the Carle providers they have come to know and trust throughout the years.”
The contract itself still needs to be signed, but the agreed-upon terms including all of the financial terms, are finalized, Aetna’s senior vice president of group retiree solutions Rick Frommeyer said in an interview with WCIA 3.
“We’ve agreed in concept to the terms,” Dennis Hesch, executive vice president and chief finance and strategy officer for Carle Health said in a separate interview Monday evening.
“But we still need to finalize the actual written agreement.”
Hesch and Frommeyer agreed they wouldn’t have made the announcement without confidence in a finalized contract in the next couple of weeks.
“That is correct,” Hesch responded. “Anytime we get into these contractual arrangements, there’s a lot of documents to it. But the fact that we’ve gotten to this point and the fact that we’re willing to release a statement, we feel very confident that we’ll get that done.”
With a finalized agreement, Frommeyer assured all Carle doctors and facilities will be reimbursed at the same rate they are currently under the soon-to-expire state-sponsored United HealthCare plan. Co-pays and payment rates should also go unchanged, he responded.
“We’re extremely happy to get this done,” Hesch said. “To be able to announce to the state retirees that they’ll be able to continue the care. I know there’s been a lot of anxiety to date on this and so we’re very happy to get to this point.”
“The terms are looking to be a five-year contract,” he added, which lines up with the length of CMS’s initial contract period with Aetna. CMS has the right to extend it another five years, after which a new bidding process would be required by state law.