Carle Health deal to be finalized mid-December, should renew access to Christie Clinic

SPRINGFIELD, Ill. (WCIA) — Representatives from Aetna and the Illinois Department of Central Management Services (CMS) spent the morning after Election Day working to ease fears in a crowded room of retired state workers over the upcoming switch in their state-sponsored health benefits from two plan options to one new, previously unknown plan, run by Aetna.

Aetna, owned by multi-billion dollar parent company CVS Health, will be unprecedentedly responsible for the benefits of roughly 140,000 retirees and dependents starting in January.

Hundreds of enrollees gathered in anticipation at the Crowne Plaza hotel and convention center in Springfield Wednesday for one of roughly 25 information sessions, one of two hosted there that day.

“It sounds to me like it’s just almost the same as the coverage I had before. I was very satisfied with it,” retired Springfield teacher Sherry Erickson said in the lobby afterward.

That was the surface-level impression. As it was laid out, the basics of the Aetna plan appear roughly identical to the state-sponsored United HealthCare Medicare Advantage PPO plan Erickson is enrolled in until it expires on Jan. 1.

Deductibles, co-pays, and out-of-pocket costs line up between the two plans. CMS representative Vanessa Shanle said retirees will also keep the free gym access available through United HealthCare. Aetna’s version of the program is called ‘Silver Sneakers’.

The difference will be the company itself. How will they handle insurance claims? Will the health care facilities and doctors that retirees see now accept the Aetna plan?

“So, you know, I’m just gonna wait and see,” Erickson said.

Several questions about whether major local hospitals or clinics will be covered came up in a stack of dozens of retiree questions collected on notecards. CMS and Aetna representatives answered them one by one.

The doctor access concern is one that was concentrated among about 11,000 retirees in eastern-central Illinois reliant on Carle Health. Following a couple of months of reporting on the widespread impact of likely losing a network of more than 550 Carle providers, Aetna and Carle Health executives came to an agreement to bring those providers into Aetna’s Medicare Advantage PPO network.

That concern did not appear to extend to the capital city.

Doctors at Springfield Clinic and Prairie Cardiovascular will be covered, Aetna group Medicare account director Mike Heck said in response to questions.

The remaining provider accessibility inquiries were redirected to Aetna clinical staff following the meeting.

If a provider says they won’t accept the plan, call Aetna, Heck and another account director Kimberly Nelson advised several times.

“So we can directly outreach to that provider to take you out of the middle,” Nelson said.

We’ve heard for months from Aetna members enrolled in the company’s existing state-sponsored Aetna Medicare Advantage HMO plan who spent hours, days, and weeks waiting on the phone before their questions ultimately went unanswered. That was before the insurer will become responsible for tens of thousands more retirees.

“We’ve got a dedicated support team,” Aetna senior vice president of group retiree solutions said in response to WCIA 3 asking, “Is Aetna going to be able to handle all of those calls from patients looking to get that outreach?”

Frommeyer, in an interview after the information session, said Aetna put together a team ahead of the new plan launch that will handle only Illinois retiree calls.

“To ensure that, you know, people aren’t waiting whole hours, or even a half hour or 45 minutes to fairly promptly have their calls answered,” he continued.

“But again, the proof is in the pudding, so we’ll see,” Erickson reiterated. “Come back and talk to us next, like in July.”

“They are exactly right,” Frommeyer said of the sentiment in his later interview. “That is incumbent upon Aetna.”

“The minute the clock strikes midnight on new year’s day, that they are, you know, that’s our plan. It’s our responsibility to ensure that we delight them in every opportunity we have to engage,” he said.

Carle Health deal to be finalized mid-December, should renew access to Christie Clinic

The contract between the state-sponsored Aetna plan and Carle Health will likely be finalized mid-December, Frommeyer said.

“These are complex contracts. And there’s, you know, the lawyers get involved and refining words back and forth. It’s nothing to do with the terms,” he said.

“We both felt confident to go public because, you know, the terms were, you know, there was agreement on the terms. Now it’s just taking all that and putting it into a contract.”

Christie Clinic specialists who Aetna kicked out of network earlier in the year should also be back in-network once the contract is finalized, an Aetna representative said in response to follow-up questions Thursday.

In May, five months after Carle Health first severed ties with Aetna Medicare Advantage — affecting Carle Foundation Hospital in Urbana and a network of more than 550 providers — Aetna knocked several Christie Clinic providers out of network as well, because of their relationship with Carle Health.

“Christie is still in network,” the email Thursday read. “We are working with Christie Clinic to reinstate those terminated Christie providers to Aetna’s [Medicare Advantage] PPO network as of the effective date of Carle’s participation in our MA PPO network.”

Some expected changes in the switch from United HealthCare to Aetna

As expected, at least a few things will change when retirees are moved from their existing plans — primarily United HealthCare’s PPO plan — to Aetna’s version.

One switch-up, in particular, that is known at this point appears to be in favor of retirees: They will owe a lesser monthly premium.

Although, CMS is poised to pay Aetna $0. When asked where the more than a billion dollars in taxes and state employee contributions that the state agency has previously spent a year on the retiree health benefits will be rerouted, deputy director of communications Cathy Kwiatkowski said, “The savings generated by the MAPD program,  which will benefit Illinois taxpayers, will be reflected in the [Fiscal Year 2024] budget.”

As for where the continued premiums for retirees with less than two decades of state employment will go, Kwiatkowski said “Members pay a percentage of cost based on the total cost of coverage which includes administrative cost.”

Mail-order prescriptions will have to go through Aetna’s parent company, CVS Health, according to representatives presenting Wednesday. The company is proactively transferring those prescriptions, according to sales vice president of group retiree solutions John Ficaro.

“If we are unable to complete an authorization before January 1, you’re going to be receiving a 30-day fill within the first 90 days of your plan,” he said.

Photo of Aetna’s preferred pharmacy list

A new list of preferred pharmacies is also associated with the plan.

Retirees already enrolled in one of the state-sponsored health plans don’t need to do anything to be enrolled in the new plan, unless they wish to alter any benefits, add dependents, etc. Those who don’t opt out will automatically be re-enrolled, Shanle explained.

ID cards are expected by the end of December, Aetna representatives said. If they don’t arrive in the mail by then, the answer was, again, to call Aetna.

For those in and around eastern-central Illinois, there are information sessions next week in Champaign, Danville and Effingham.