On its website<\/a>, BJC said: \u201cAfter years of trying to resolve administrative burden and payment issues with both Aetna and Anthem, BJC made the difficult decision to no longer partner with these plans. We did not wish this to be the outcome. Like almost 200 other health systems across the country, BJC has had to end its relationships with certain Medicare Advantage plans. We will only contract with plans\u202fthat\u202fhave reasonable terms and conditions\u202ffocused\u202fon patients\u2019 best interests.\u201d<\/p>\nThe change means no in-network access to the primary care providers, specialists and hospitals patients have relied on. Aetna and Anthem said they have resources to help people find in-network providers.<\/p>\n
BJC HealthCare\/Saint Luke\u2019s in St. Louis and Kansas City, in alignment with Washington University School of Medicine physicians, have unfortunately informed us that they are reducing access for Medicare advantage members. While we remain willing to work with BJC\/Saint Luke\u2019s and Washington University School of Medicine physicians to reach a fair agreement that keeps them in our Medicare network, they will no longer be in network for Aetna Medicare Advantage members beginning January 1, 2027.<\/p>\n
Aetna has a robust provider network in both the St. Louis and Kansas City areas available to care for our members. We are available to help members who have questions, and they can reach us by calling the number on their membership ID card.<\/p>\n
Following constructive discussions, BJC and Anthem mutually agreed that BJC will no longer participate in our Medicare Advantage network effective January 1, 2027. We are helping affected members find other in-network providers and supporting a smooth transition of care. We will also help members with certain serious or complex medical conditions continue receiving care from their current providers beyond December 31, 2026, when medically necessary. Anthem Medicare Supplement plans are not affected by this change. Members can learn more at Anthem.com\/update\/bjc or call the customer service number on their member ID card.<\/p>\n
Minor said BJC\u2019s letter suggested Chapter Advisory to help find other Medicare coverage.<\/p>\n
\u201cSo like BJC, the letter that they sent, they suggested Chapter Advisory as someone who can help us find other Medicare coverage. I had to spend time on that. Chapter Advisory wants a list of all of your providers and their addresses. They want a list of all of your medicine,\u201d Minor said.<\/p>\n
The change leaves patients like Minor exploring options such as finding another Medicare Advantage plan, switching to original Medicare, or changing doctors. Minor said going back to original Medicare would require underwriting approval for gap insurance, and she is uncertain whether she and her husband would qualify given his health history. She said other Medicare Advantage plans she has reviewed are not as good as her current plan.<\/p>\n
\u201cI know what my choices are, but I don\u2019t like my choices. I would prefer to stick with what I have,\u201d Minor said.<\/p>\n
Illinois state lawmakers said they have heard concerns from constituents.<\/p>\n
\u201cI\u2019m hearing a lot of panic and confusion from folks that really want to make sure they can go to their doctor. They want to make sure that they can continue with treatments that they are going through. They just want to know what the future holds. They want to have firm answers if they need to make any changes to what their benefits are. It\u2019s put people in a place where it feels very unsure,\u201d said State Rep. Katie Stuart, D-Edwardsville, 112th District and Assistant Majority Leader.<\/p>\n
Stuart said retired employees are receiving notices from both Aetna and BJC stating they will be out-of-network, but many are unclear about what that means.<\/p>\n
\u201cDoes that mean I can\u2019t go to my doctor anymore? Depending on what plan they\u2019re in, some retirees have no other option but Aetna. So, they\u2019re not sure what this means, if they can use BJC again. BJC has some really highly specialized areas of coverage. They\u2019re very worried about having to travel to, you know, Nashville or Chicago or somewhere like that in order to get these specialty doctors,\u201d Stuart said.<\/p>\n
State Rep. Charlie Meier, R-Okawville, 109th District, said he\u2019s hearing similar things and retirees have described built relationships with their doctors.<\/p>\n
\u201cThese are relationships they\u2019ve built with that doctor over the years. That doctor has maybe saved their life through cancer treatments, through heart treatments, and now they\u2019re being told they can\u2019t go and see that doctor again. So there is fear and anger in their voice, and rightfully so. We have to do something,\u201d Meier said.<\/p>\n
Meier said southern Illinois lawmakers sent a letter demanding CMS, Aetna and Barnes-Jewish meet and develop a plan, requesting a response by Nov. 12.<\/p>\n
Meier said CMS could address the issue by reaching a direct agreement with Barnes or by adding another health insurance system, such as Devoted Healthcare, Essence, Humana or United Healthcare.<\/p>\n
Meier said patients currently undergoing treatment at Barnes will be able to continue that specific treatment past Jan. 1 under a continuity-of-care clause if they have a written agreement with Aetna acknowledging it.<\/p>\n
Meier said southern Illinois has limited health care options outside of Barnes, including for specialty treatments such as transplants and gene therapy.<\/p>\n
\u201cThis is affecting more than 5,000 people here in Southern Illinois. These are people who\u2019ve worked for the state their entire life. We need an agreement. We need something worked out to protect them. They believe they have health insurance. They need to have it. They don\u2019t want to drive two, three, four, five hours when you can be in Barnes Hospital in 55 minutes,\u201d Meier said.<\/p>\n
Stuart said the change does not affect emergency care.<\/p>\n
\u201cI also want to make sure that people understand this doesn\u2019t affect emergency care. If you need emergency care, please go. Please take care of yourself. That is covered, you know, regardless of network status. It doesn\u2019t require prior authorization. So if you have an emergency, if you are having a stroke, if you are having a heart attack, or if you are just worried that\u2019s what\u2019s happening, go get care,\u201d Stuart said.<\/p>\n
Meier said retirees can change plans, but would then pay for coverage themselves rather than the state.<\/p>\n
Stuart said the situation reflects broader issues in the health care system.<\/p>\n
\u201cIt points to that our medical system isn\u2019t always patient-focused, and that there has to be a better way that we can do that. Obviously, I\u2019m going to do everything I can. I\u2019m going to connect with my colleagues from all over the region,\u201d Stuart said.<\/p>\n
Stuart provided a resource guide put together to help people navigate this change. <\/p>\n
Stuart said she can be reached at repkatiestuart@gmail.com<\/a> or 618-365-6650.<\/p>\nEvery Illinoisan deserves access to quality, affordable care, and no one should have to worry that a contractual dispute between an insurance company and health care provider will stand between them and the treatment they need. Aetna and the BJC network must do everything in their power to preserve Medicare Advantage health coverage for thousands of Illinoisans who rely on it, including 5,000 State of Illinois retirees across the region. It is greatly concerning that these entities are willing to strip healthcare access for thousands of Illinoisans and we urge them to seriously and fully evaluate all potential options to reach an agreement.<\/p>\n
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