CHAMPAIGN COUNTY, Ill. (WCIA) — The network of doctors for a number of state retirees living in Champaign County was diminished for a second time this year.

Carle Foundation Hospital in Urbana severed its ties with Aetna Medicare plans fewer than three months ago and as of May 1, Aetna intends to drop several Christie Clinic providers in Champaign, Urbana, and Mahomet out of its network because of their relationship with Carle.

Vicki Good — a retired central Illinois teacher — signed up for Aetna’s Medicare Advantage HMO plan when she moved to Champaign. It’s one of two health insurance options for state retirees in Champaign County enrolled in Medicare. The other is United Healthcare PPO.

Vicki Good shows reporters a map of TRAIL (Total Retiree Advantage Illinois) plans available to her by county

“When it was open enrollment time, nobody said, ‘Oh, by the way, we’re going to be dropping a lot of doctors out of network,'” Good said.

Her primary care doctor is at Christie Clinic, that is until her insurance will no longer cover the cost on May 1. Good was first notified of the network change in a March 1st letter from Aetna.

A phone number for an alternative doctor was included, but when she called, “and I said, ‘Is he accepting new patients?'”, the receptionist on the other end of the line said, “No,” and “Not only that, he’s [also] going to be out of network as of May 1.”

The domino effect began when Carle Foundation Hospital terminated its contract with Aetna Medicare, knocking all of its healthcare providers out of network for those patients as of January 1, 2022. Carle, Aetna nor Christie Clinic would address why clinic providers are being kicked out of network four months later.

Christie Clinic’s Chief Financial Officer Anni McClellan says “less than 17 of our 179” primary care doctors and specialists will no longer be available at in-network rates for Aetna Medicare patients because of their affiliation with Carle Hospital. It’s common practice for physicians at clinics without emergency rooms to obtain admitting privileges with local hospitals.

We’re told the “less than 17” number is an estimate of how many providers have been notified so far by Aetna.

“I really feel like I don’t know what to do about health care,” Good expressed. “My question, you know, for Aetna is, what am I supposed to do in this transition time? You know, I’m very lucky. I’m a very healthy person in general. But what should I do if I have a heart attack?”

The Illinois Department of Central Management Services (CMS) administers Medicare plans for state retirees.
Cathy Kwiatkowski, the deputy director of communications said physicians were “given the opportunity and time” to get admitting privileges at other hospitals. She said in a statement Wednesday, “The physicians that are no longer in the network did not exercise this opportunity.”

“I just feel like they took advantage of us.”

Vicki Good, retired school teacher

559 retirees in Champaign County are enrolled in the Aetna Medicare plan, according to Kwiatkowski.

The state was “unable to provide an estimate as to the number of members who may be impacted.” Kwiatkowski said CMS doesn’t collect that data. Carle Foundation Hospital passed the question off on Aetna, who did not respond to any request for comment Wednesday.

Courtney Luth, the regional director of physician practice at OSF Healthcare in Urbana says Aetna Medicare patients make up roughly 11% of their overall patients.

The hospital has started to see an influx of new patients since January, according to Luth, something she says their providers are equipped to handle.

“So far, we have been able to, you know, provide the service that they’ve asked us to provide,” she added when asked if they have access to every type specialist requested.

For now, Vicki Good said she’s waiting to see if a re-negotiation is in the cards for her insurer and Carle-affiliated doctor..

“And I just refuse to go through their whole directory calling doctor after doctor, after doctor, trying to find out who really is going to be a provider in-network,” she said. “Their bottom line is they want to make a profit for their company…But it just seems like they are taking more and more choices away from us.”

McClellan, Christie Clinic’s CFO says they’re working on “additional hospital relationships” that would be in-network for Aetna patients.

READ THE FULL STATEMENT FROM MCCLELLAN:

At this time (3/22/22), less than 17 of our 179 providers (both primary care and specialists) at Christie Clinic have received notification from Aetna that they are now terminated and out-of-network for Aetna Medicare Advantage plans (PPO and HMO) as of May 1, 2022. These Christie Clinic providers are now out-of-network due to their hospital relationship being at Carle Foundation and which is now not an Aetna in-network hospital. Though Christie Clinic did not terminate its contract with Aetna Medicare Advantage, we expect additional providers to be designated as out-of-network. Patients can continue to see Christie Clinic providers even if their provider is now an out-of-network Aetna Medicare Advantage provider, but they may experience higher co-pays or have higher out-of-pocket costs than in-network. Christie Clinic and these providers were notified their plan participation termination was due to Carle Foundation Hospital’s participation in Aetna’s Medicare Advantage products ending on December 31, 2021. Christie Clinic is working on additional hospital relationships that are in-network for Aetna for some providers where applicable to enhance coverage. Aetna patients should contact Aetna to better understand their coverage.

READ THE FULL STATEMENT FROM CARLE FOUNDATION HOSPITAL:

What I can share is that the Carle system works closely with insurance plans to ensure robust coverage options are available. Aetna’s previous Medicare Advantage HMO and PPO did not include complete access to the Carle system, specifically the Carle Physician Group, and it’s our goal to align offerings throughout the region, so that particular plan was discontinued at the Urbana hospital on Jan. 1, 2022. However, we will continue to accept a range of Aetna plans at Carle Foundation Hospital and throughout the region. You can find a list of active insurance provider relationships, by location, on Carle.org.

If you or someone you know is affected by this change in the Aetna Medicare provider network, email us at Target3@wcia.com.