Other Routes to Coverage for Carle Doctors in New State Health Plans

The state's rejection of Health Alliance from its new menu of health plans for state employees has prompted the Urbana-based medical plan provider to mount a campaign in its own defense --- including the filing of a formal protest with the state.

Health Alliance officials note that they provide exclusive HMO coverage for several providers including Carle (Health Alliance and Carle Physicians Group are both owned by the Carle Foundation). Without a Health Alliance plan, state employees and retirees will have no access to those doctors under an HMO plan.

But the new health plans for state employees offer other plans that include Carle. They are open access plans --- three-tier plans that work like HMO's at their lowest tier, but offer more expensive access to more doctors at their 2nd and third tiers. Two open access plans from PersonalCare and HealthLink would offer access to Carle doctors at their 2nd tier.

Without giving specific numbers, PersonalCare CEO Todd Petersen says the price difference between Tier One and Tier Two is not a big one.

"There is a difference in deductible and co-payment," Petersen said. "They (the 2nd tier prices) would be a little bit higher. But it's still --- compared to the general market --- it would still be one of the richest benefits on the market today."

Petersen predicts that Carle and and other providers with exclusive contracts with Health Alliance will make arrangements with other health plans --- but not until after Health Alliance's formal protest is heard.

"But then, I do expect that the market will adjust to the new realities and you're likely to see providers participating in products that they have historically not participated in," Petersen said.

In the meantime, Petersen notes the bottom tier of PersonalCare's open access plan includes several central Illinois medical groups and hospitals, including Christie Clinic, Provena, Sara Bush Lincoln and hospitals in Gibson City and Decatur.