Dear Editor,
In May 2017, the State of Illinois made a change with insurance providers as Cigna Insurance left and was replaced by Aetna Insurance. There has been misinformation and rumors in the public about those specific insurance changes, and usually there is always more to the story.
McDonough District Hospital was not notified of any insurance changes by the State of Illinois or Aetna until a patient asked a question on May 4, after the open enrollment period had already begun. MDH attempted to contact Aetna, which that alone took over 10 days just to track down a point of contact person.
MDH sent a Letter of Agreement to Aetna on June 7, 2017, with that proposal covering State of Illinois participants. The letter covered typical medical costs and percentage discounts, the same competitive pricing structure that was in place with Cigna. MDH did not receive a response. The Letter of Agreement was sent to Aetna a second time, that proposal was rejected. They finally contacted MDH mid-September stating they would put together a counter-proposal. MDH received their proposal on October 16. The pricing and discount terms were not fair and reasonable for the hospital.
After several conversations, MDH countered Aetna’s offer on November 13. Three days later the company responded back with virtually the same unreasonable offer as October. MDH submitted to Aetna on December 8 yet another proposal. Two weeks later Aetna stated it would not be able to meet the suggested pricing and went away from the negotiating table.
As a business, we work towards contract parity. It’s difficult to come to a partnership agreement when the other party is unwilling to budge on their unreasonable and unrealistic reimbursement pricing.
MDH is not aware of what agreements are in place with Aetna and other facilities because all of those arrangements are protected by confidentiality clauses.
Some State of Illinois participants are affected by this situation. Patients currently with Aetna can change their insurance coverage plan this May during the next open enrollment period with the change going into effect on July 1, 2018. There are good, similarly priced insurance options for those State of Illinois members wanting to switch and stay within the McDonough District Hospital network of providers and services.
This summer MDH will celebrate its 60th anniversary. The hospital’s leadership must make decisions that focus on quality patient care, yet still be fiscally sound, to ensure MDH will be serving west central Illinois for the next 60 years and beyond.
Patrick Osterman
Leader of Public Relations and Marketing
McDonough District Hospital