Bob and Pat on the TRAIL.

Dear Robert, Fred,

I just wanted to report in on my experiences with TRAIL options and information for those of us affected in DuPage county.  We have two choices, UnitedHealthCare Group Medicare Advantage PPO and the second is the TRAIL Humana Health Plan HMO.

For decades many of us have had BC/BS HMO Illinois beginning when we were working and then through TRIP in retirement.  Apparently that will be gone.  Experience of my colleagues in that plan has been good even when the health problems were dire.  Many of us went from it being Glen Ellyn Clinic decades ago to DuPage Medical Group and were satisfied.  So I am interested to see if TRAIL Humana Health Plan HMO might be a comparable replacement.

I was expecting information from them this week.  Not receiving anything, I called them yesterday.  They said that “UPS will deliver information tomorrow.”  In the mean time, I asked about a few providers, such as:  is DuPage Medical Group in the network?  Can’t really answer.  Go online (many retirees are not connected, why call if they can’t answer?).  They said it will be in the mailed information.

So I called TRAIL Humana late today to tell them I have received nothing again.  They now report I may not receive anything until as late as November 19.  Then some excuses about Veteran’s day as if they didn’t know the 11th was Veterans Day weeks in advance.  So then I said, it appears as if Humana doesn’t really want the business TRAIL represents.  Why get a contract from the State of Illinois and then provide such terrible service when we haven’t even signed up yet?  The State of Illinois already knocked out Health Alliance which underbid all others for providing healthcare for downstate retirees and had long been their provider.

From Capitolfax:

http://capitolfax.com/2013/10/24/something-just-doesnt-seem-right-here/

* Insurance giant Health Alliance claims it seriously under bid all of its competitors to provide Medicare Advantage for thousands of Downstate public employee retirees…

* So, why was the company disqualified? State experience requirements…

Health Alliance spokeswoman Jane Hayes said the contract selections are puzzling, “because we’re often seen as too expensive.”

“Of course, they probably didn’t even look at the pricing, because we were thrown out on a technicality that the (state) chief procurement officer could have waived,” Hayes said.

The technical requirement Health Alliance didn’t meet pertained to experience administering large-member Medicare Advantage contracts.

The state required insurance vendors seeking the Medicare Advantage contracts to show they have at least five years’ experience administering Medicare Advantage plans — plus at least three years’ experience administering Medicare Advantage plans for at least one employer with a minimum 1,000 participants enrolled. Bidders also needed to show they had at least one year’s experience administering a Medicare Advantage plan for a government employer with at least 500 participants.

It would be upsetting for these downstate retirees as getting care in a rural area often means fewer providers and often many miles away to their doctor and now they have only one choice UnitedHealthCare PPO.

In DuPage County location is not a problem.  Providers are down the street and UPS is in the next suburb.  This adds to the mystery of Humana’s incompetence.  Why bother making sure the bidders have “at least five years’ experience administering Medicare Advantage plans” when already they can’t get information to TRIP-TRAIL retirees.  And the sender is UPS.  DuPage county is not Siberia.  UPS and the postal service are very reliable at delivery and have huge centers in Carol Stream and Lombard.  So the problem is Humana who apparently has the bid because of their experience and they can’t deliver.

Patricia Herrmann

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Pat,

Your concerns were raised at the TRS meeting in Schaumburg on Wednesday by one questioner.  If there was a good response, I did not hear it.

Interestingly, my neighbor received her Humana packet yesterday, but she is not in TRIP.

Lastly, in part at least because of pricing, I don’t know of a single person who is any longer considering Humana.  Questions raised in the forums I have attended have almost exclusively focused on the PPO.

Bob Zahniser

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UPDATED.

Pat,

The CMS meeting in Buffalo Grove this morning was standing room only.  While UHC had a large presence (CMS ran the meeting), Humana was nowhere to be seen.  Again, questions were 99% focused on UHC with seemingly very little interest in Humana.

In addition to Senator Morrison and Representative Drury, Representative Nekritz was present and at meeting this morning.  When introduced, she was booed.

Bob