Teacher and Special Education advocate Bev Johns is attending the CMS meeting in Springfield today. She is sending me frequent reports from the meeting which I will repost during the day. Check back during the day for her latest comments.
9:02 AM: We arrived. Hard to find. Most people parked illegally in a lot that has a tow away sign. Janice Bonneville from CMS is here. Crowded already and it is still 30 minutes away from starting.
9:07 AM: Received united health care PPO plan and Humana HMO plan. Coventry says their plan is in the mail.
9:18 AM: For state employees PPO copayment Is 10 percent. For teachers it is 20 percent.
9:33 AM: PPO copayment for physicians pay out of network providers according to Medicare’s allowable fee schedule.
9:37 AM: “The health providers in our network can change at any time.”
9:56 AM: PPO in all 102 counties in Illinois, Coventry in 47, Humana in 13 counties.
10:02 AM: Janice from CMS, yes the same person testified before COGFA, says that for PPO CMS has been very successful in getting doctors who say no to PPO to say yes.
10:32 AM: In PPO if your doctor is not wanting to take the plan you may be required to pay upfront.
10:38 AM: Bonneville says there is no lifetime cap. She is also saying that PPO will cover anywhere in United States. Deductibles are based on Medicare allowed charges. Out of pocket maximum is based per insured person.
10:42 AM: Will pay out of the country only for a medical emergency.
10:44 AM: Just announced they are towing cars in one of the parking lots.
10:52 AM: About 40 people had to leave because of cars being towed.
10:56 AM: Question–why weren’t people allowed to keep their plans they had. Bonneville–we had goals and we had to meet those goals.
10:58 AM: She was asked what their status was. Health alliance didn’t meet specifications.
11:01 AM: Enrollment form is 8 pages long.
11:05 AM: Bonneville said they are working on legislation to allow people who get out of Medicare to get back in.
11:07 AM: What I meant was she is working on legislation that you could get back into the state plan if you opt out. You can now go back to Medicare now.
11:10 AM: People thought they could get a supplement with the new plans of advantage but they were told no they can’t.
11:15 AM: I asked what happens to people who are in some type of treatment and the PPO doctor says no longer. Not answered but told they would develop transition plan.
11:19 AM: Luckily we didn’t get towed.
11:25 AM: After the questions on cards they did allow questions from audience. People very worried about cancer drugs etc. Janice Bonneville admitted some people will lose some previous benefits.
Fred Klonsky 
In the TRAIL “Your Retiree Healthcare Decision Guide”, which arrived in today’s mail, on p. 11, “Comparing the Medicare Advantage Plans”, the UnitedHealthcare PPO states that for Doctor office visit, specialist office visit, inpatient hospital, outpatient surgery, diagnostic tests, “Plan pays 80%; you pay 20% after annual deductible”. My question is, does the plan pay 80% of whatever Medicare does not pay, or 80% period. Medicare usually pays about 75- 80 %, I think, with Cigna picking up 80% of the remainder. What I’m trying to understand is, will UnitedHealthcare PPO do the same, or are they only paying what Medicare pays. Are they providing the coverage of both Medicare AND 80% of the amount not covered by Medicare? If all they’re paying is what Medicare will pay, we’d be better off saving the “Medical Contributions”. I live in Mississippi, thus will be unable to attend any of the Seminars.
An additional question involves the Disclaimer on page 12 of the afore mentioned “…Guide”. It states, “The State of Illinois intends that the terms of this plan are legally enforceable and that the plan is maintained for the exclusive benefit of Members. The State reserves the right to change any of the benefits, program requirements and contributions described in this …Guide. This Guide is intended to supplement the Benefits Handbook…” Since we have not received the Benefits Handbook, how can we know what these benefits and requirements are? How can we say we will accept these unnamed benefits if the State can change these benefits, requirements and contributions at any time?
I would appreciate any enlightenment you might provide. Thank you!
Carol
All good questions that must be directed at the union leadership and CMS.
The Medicare Advantage plan offered by UHC offers the same benefits as Medicare; i.e.: it pays 80% and the plan participant pays 20% AFTER the deductible of $250!
There are no more payments from Medicare because the Advantage plan replaces it.
Apparently the additional premium will pay for the prescription drug coverage.
People in the Chicago metro area will want to know the list of hospitals that accept this UnitedHealthcare PPO for TRS members. It won’t do us much good if places like Northwestern, Rush, U of I, etc…. (The primary care hospitals) are not included.
Help! On the website, it says, ” If you enroll in the UnitedHealthcare plan, you do not have to see a provider who accepts the UnitedHealthcare plan. However, the provider must participate in Medicare. The overwhelming majority of providers in Illinois and across the nation are Medicare providers and participate in Medicare Advantage plans. If you are seeing a Medicare provider, he or she will most likely be willing to file claims with UnitedHealthcare and bill you for your coinsurance (your share of covered expenses). If your provider is not willing to file a claim with UnitedHealthcare, please notify Customer Service at (888) 223-1092 to have UnitedHealthcare contact the provider on your behalf. If your provider is still not willing to file a claim with UnitedHealthcare, you may pay the provider directly and submit your receipt for reimbursement to UnitedHealthcare”
That “you MAY pay the provider” is unclear. Is there really a choice???
Here’s something strange. My email contact at CMS replied:
“I will be out of the office from Monday, November 11th through Friday, December 13th. I will have limited access to email while I am away.
If you need immediate assistance, please contact a member of the MCOB Unit at 1-800-442-1300 x 7007.”
I prefer written answers to questions.
Has all of CMS email shut down?