URBANA, Ill. (WCIA) — Unexpected medical bills are piling up for another retired state worker who found themselves caught in the middle of a break-up between Aetna Medicare and Carle Health.
Evelyn Burnett Underwood, 79, was born in the rural south in the early 1940s. Her left leg was severely burned in a childhood accident when she was 3 years old, and she’s required a lifetime of regular medical care ever since.
“I had to learn how to walk again,” Underwood said. “We lived in Mississippi, and my mom had to take me to Tennessee because, you know, they weren’t seeing Black people back then.”
Underwood and her family relocated to Urbana in the 1950s where she still lives with her husband after a 20-year career at the University of Illinois.
70 years later, she still suffers from severe pain and swelling in her leg.
Her doctor calls it calcinosis cutis, “because it’s just like growing grass on concrete because all the calcium, and then my diabetes exacerbates it,” Underwood said.
“All my life. I have to be careful, you know, not to hit it or anything. And if so, it’ll get worse. And then I will have to have skin grafts.”
It’s not uncommon for her symptoms to get bad enough — or for her wound to re-open enough — that she said has to see her Carle Wound Healing & Limb doctor at Carle Foundation Hospital weekly “to try to get some more of that calcium out.”
It’s the only facility within an hour of Underwood that does this treatment she’s come to rely on, and that was not a problem until Carle terminated a contract with her Aetna Medicare insurance plan, effective Jan. 1.
Aetna initially gave Underwood prior authorization, agreeing to continue covering her care with this doctor at the in-network rate until May.
Feeling assured, Underwood kept seeing her provider. Then the bills arrived, totaling at least $13,000 for services in January, February and March that are normally taken care of with a co-pay.
“It’s critical, you know, you can’t have an open wound,” Underwood said, not knowing where else she could turn.
“Every time it was always something, always something so they can charge me,” she said referring to her insurer.
Underwood filed a complaint to contest the first bill with a price tag of more than $5,000. An Aetna representative helped her through the appeal, and “I thought I was doing an appeal for everything,” she said.
Aetna ultimately approved the appeal, but documents show the company agreed to pay just a fifth of the bill. Underwood said she found out in one of many phone conversations with her insurer that the continued coverage does not extend to everything that was included in her appointments.
“Well, I don’t know what he’s gonna do,” she said of her doctor’s appointments. “I’m the patient. He does what he needs to do.”
Although, Underwood said she’s seeing one wound doctor for a singular purpose, “so it’s only this one for the same thing”
She’s continuing to navigate the complaint process for the remainder of her claims. In the meantime, she took care of her co-pays and asked Carle to put a hold on her bills. She said the health system agreed to do so, but she’s still getting calls and letters.
“They’re calling me at night, at 6:30 at night. My husband can tell you, saying that they’re gonna put it in collection. And now they’re sending me letters from South Carolina, North Carolina, saying I need to pay.”
Carle public relations manager Brittany Simpon didn’t respond to questions about whether Underwood’s bills remain on hold. She said the company has been in contact with Aetna to offer support during the appeals process.
“…Carle works closely with patients, as we have with Ms. Underwood, to review all billing concerns in detail,” Simon said in an email response. “We commonly contact insurance providers to offer support during an appeals process and did offer additional material verification in this case.”
Insurance appeals can be a lengthy process, and in the meantime, the most critical impact is that Underwood has stopped seeing her doctor.
“They say I can no longer see him,” she said. “I can’t make appointments over there, because my insurance would not allow it either.”
Instead, Underwood is taking extra caution, but the need for treatment has been an inevitable constant in her life for years.
“I’m doing all I can to keep it from swelling, you know, I have my special shoes, and I just stay off my feet,” she shared. “But, I’m scared. If it bursts open, what am I gonna do?”
The next closest wound clinic is about an hour away, and that’s if it’s in-network. Regardless, Underwood and her husband are not able to drive.
Aetna did not respond to questions about whether the company has plans to re-run the rest of her claims or help her find an accessible doctor.
Underwood enrolled in her Aetna Medicare insurance plan through the Illinois Department of Central Management Services. Given her critical need for a nearby specialist, reporters asked the state agency if the break-up between one of its administered plans and the largest health system in the area should count as a qualifying event for her (and other patients) to opt into another plan that actually serves their needs.
Media representatives expressed sympathy in a statement, but said “Aetna Medicare HMO members were notified prior to the open enrollment in October/November 2021 that Carle would no longer be in network for that plan.”
The remaining choice for Champaign and 46 other Illinois counties was a more expensive PPO plan through United Healthcare. These plans cover care virtually anywhere, and as Underwood pointed out, the added price is typically more practical for people who travel a lot or have a second winter home in another state.
Simon added: “Carle patients with a concern about a payment can contact Patient Financial Services representatives Monday – Friday from 8 a.m. to 5 p.m. at (888) 712-2753.”