Chambana Sun

Illinois state Sen. Chapin Rose (R-Champaign) recently criticized Gov. JB Pritzker, saying he is to blame for potential issues with state retirees' medical care.

The senator made his comments in a Facebook post this week.

"Pritzker to retirees: you can keep your doctor - MAYBE," Rose wrote in his Facebook post.

In his Facebook post, Rose shared a link to an article from The News-Gazette focusing on Carle Health's position on whether or not it will treat state retirees who enroll in the only health plan option the state is offering them for next year: an Aetna Medicare Advantage PPO plan. This is because there is not a current contract with Aetna.

“Due to the historical challenges in dealing with Aetna, Carle is not committing to see these Aetna Medicare Advantage PPO members without a contract,” Dennis Hesch, Carle’s executive vice president and chief financial/strategy officer, said in the article. “If Aetna offers a contract Carle feels is fair and protects Carle’s interest, Carle will treat these members.”

The Aetna Medicare Advantage Plan is the only option that state retirees will have for possibly the next five years, a recent WCIA report said. But a Carle Health representative noted that Carle Foundation Hospital in Urbana and Carle Physician Group (with more than 500 doctors) are still evaluating their “ability to support these passive PPO members,” citing cost concerns and “awaiting a formal announcement of a payor contract decision from the State.”

“If an out-of-network provider is willing to see a member and is eligible to receive Medicare payment, Aetna will pay 100% of the Medicare allowable rate for covered services,” an Aetna representative told WCIA. The representative claimed that “the member will pay in-network co-pays” regardless of the fee an out-of-network provider charges.