Guest guest Posted May 12, 2011 Report Share Posted May 12, 2011 It gets better. Medicaid has my daughter down for head of case, so I have to get that changed or they won't talk to me. The DHS Info hotline is busy, so it just disconnects you. I had called one of the plans, Aetna, and they have informed me that Loyola chose to decline participation. That is just great. I had switched all of Angel's doctors to a Loyola doctor because they accept Medicaid. > > Lucky me. I got the enrollment package today. I live in Downers Grove. The closest hospital, a level 1 trauma center where our paramedics would take us, Good Samaritan, is not on the list. All of Angel's doctors are with Loyola. Loyola is not on the list. > > What moron came up with this great idea? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2011 Report Share Posted May 12, 2011 I went to the Arc's presentation on this: if your provider is not enrolled in either MCO (yet, because they are still in the process of doing this) you can ask if they are enrolling and in which one, if they are not, ask for a " single case agreement " . For more info about this contact Fay at Arc of illinois. You have 60 days to do this and in any case 90 days to continue with your current provider or ask HFS for more time. Thais Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2011 Report Share Posted May 12, 2011 Thanks Thais. Loyola has decided not to enroll. I called Loyola and I was informed that a PCP can make a referral to a specialist at Loyola. That would mean I only have to change my daughter's PCP (whom I like, so I'm not too happy about this). My husband is looking into adding Angel to our health plan at work. It is a small company, so the premiums are high. > > I went to the Arc's presentation on this: if your provider is not enrolled in either MCO (yet, because they are still in the process of doing this) you can ask if they are enrolling and in which one, if they are not, ask for a " single case agreement " . For more info about this contact Fay at Arc of illinois. > You have 60 days to do this and in any case 90 days to continue with your current provider or ask HFS for more time. > Thais > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2011 Report Share Posted May 13, 2011 Medicaid had my daughter as head of case and had her name wrong. I faxed them a copy of my Guardianship papers which took care of both problems. ~ Propheter - Geneva IL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2011 Report Share Posted May 13, 2011 Thanks Chris. The person I had talked to, gave me a hotline where she said they could expedite the change. Unfortunately, typical state incompetence, when the lines are busy, instead of allowing the caller to wait, they just terminate the call and say 'good bye'. > > Medicaid had my daughter as head of case and had her name wrong. I faxed > them a copy of my Guardianship papers which took care of both problems. ~ > Propheter - Geneva IL > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2011 Report Share Posted May 13, 2011 We have a similar situation in our area...no nearby hospitals (including the one that is less than two blocks from Noah's house) and neither his internist nor his psychiatrist are in the Aetna Network. We also had some problem with the HIPPA rules...we had to fax guardianship papers to be able to complete the registration process. Then, I got a call just last week from someone at Aetna, to talk about case management, but the person on the phone wouldn't talk to me unless I resent guardianship papers. I probably don't have to tell you what I told her, since it wasn't very nice... If you have any concerns you want to discuss with an Aetna representative, the person I have been sharing my concerns with is: Caroline () Hall HallC1@... Aetna Better Health Member Services Manager 1-866-212-2851 www.AetnaBetterHealth.com/Illinois I don't have a similar contact at Illini Care... We have already received our membership booklet for Noah and it states that a person in need of immediate emergency care can receive treatment at the nearest hospital, but it also states that transfer to an in-network hospital should occur as soon as the member is stabilized. This concerns me. We need to share our stories...so please post and let's keep a vigilant watch...thanks Thais for your helpful suggestions/comments. Ellen Ellen Garber Bronfeld egskb@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2011 Report Share Posted May 13, 2011 My brother in law is a doctor. I just told my sister about this program. I knew my brother in law didn't accept Aetna, but I didn't know why. Sis says Aetna is bad at paying and is always looking for ways to decline a claim. Lovely <sarcasm> > > We have a similar situation in our area...no nearby hospitals (including the one that is less than two blocks from Noah's house) and neither his internist nor his psychiatrist are in the Aetna Network. We also had some problem with the HIPPA rules...we had to fax guardianship papers to be able to complete the registration process. Then, I got a call just last week from someone at Aetna, to talk about case management, but the person on the phone wouldn't talk to me unless I resent guardianship papers. I probably don't have to tell you what I told her, since it wasn't very nice... > If you have any concerns you want to discuss with an Aetna representative, the person I have been sharing my concerns with is: > Caroline () Hall > HallC1@... > Aetna Better Health > Member Services Manager > 1-866-212-2851 > www.AetnaBetterHealth.com/Illinois > > I don't have a similar contact at Illini Care... > We have already received our membership booklet for Noah and it states that a person in need of immediate emergency care can receive treatment at the nearest hospital, but it also states that transfer to an in-network hospital should occur as soon as the member is stabilized. > This concerns me. We need to share our stories...so please post and let's keep a vigilant watch...thanks Thais for your helpful suggestions/comments. > Ellen > Ellen Garber Bronfeld > egskb@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2011 Report Share Posted May 20, 2011 Thanks for offering to compile the information, . I am sending bits and pieces, as I get comments, back to the representative at Aetna (I don't have a contact at Illini Care) and I cc everything to Hamo ....They need to be hearing the stories... Ellen Ellen Garber Bronfeld egskb@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2011 Report Share Posted June 10, 2011 , I'm story # 3. I should have added that it took me six months to get a psychiatrist for my daughter. Is it going to take that long for me to get her to see a new one? What about the dangerous meds that she is on? > > Bonnie, > > Here is what I have so far. > > > > Illinois Integrated Care Pilot > > The first few weeks….. June 6, 2011 > > … Thoughts from parents who are trying to coordinate their child’s medical care…. > > Story #1 > > I got Bill's packet today, too....went over to his primary for the last 6 years -- not signing up. So we get to start from scratch again. IlliniCare has only 1, ONE!, physician in all of Naperville; and that office is 20-30 minutes away. No hospital, on either plan. So our closest medical center in case of emergency is 30 minutes away: Adventest Bollingbook Hospital. And this is a GOOD thing? What if the PCP is not allowed to practice in Bollingbook? > > It is just so frustrating that this was forced on the least vocal, most medically compromised individuals in our society not under Medicare only to benefit one man: Governor Quinn. Is HE on this plan? > > Story #2 > > > > We are now in the throws of trying to figure out what to do with the changes in Medicaid that are being forced upon our daughter, as a handicapped adult, by the State of Illinois. > > > > My wife and I have spent a great number of hours on the phone these past few days with Integrated Care, IlliniCare, Aetna Better Health, various hospitals, and various doctors' offices trying to find out if anyone is joining these new networks that are being thrust upon us. To our dismay and tremendous frustration we have been told by ALL of 's doctors, specialists, and hospital (Northwest Community Hospital) that none of them have joined, nor are they planning to join, either of these programs. > > > > has some very specific health needs and this now puts her in a very precarious and dangerous predicament. > > > > I am writing to ask if you know about these changes and if anything is going on from a legal standpoint to try to fight this. > > It seems clearly discriminatory that the State of Illinois has singled out " older adults " and " adults with disabilities " as the two groups who are affected by these changes. Is there anything we can do to keep with her present physicians and hospital? Or is there some avenue we may pursue to fight this? > > > > Any help you can offer will be greatly appreciated. > > > > Story #3 > > So, how does this stupid program affect my family? > > Well, the closest hospital, a level 1 trauma center, is Good Samaritan. It is not listed. Less than a mile away, Good Samaritan has an emergency outpatient facility, which I have used for my daughter (also used it for hubby). It's much easier than going to the ER at Good Samaritan. > > All of Angel's doctors are now out of Loyola. I did that on purpose - because Loyola accepted Medicaid, they have a great reputation, and a Loyola Primary Care facility is walking distance from me. Angel's new PCP is there, plus her new podiatrist is there once a week, making Angel's medical care easier. Angel goes to Loyola University in Maywood for her psychiatric care. She's been doing this for, I believe seven years now. Again, at the time, Loyola was selected because it's a university medical center and getting her psychiatric help when she was 15 was easier and quicker (though I did check out some of the hospitals listed). > > My brother in law is a doctor and he does not take Aetna. My sister did not have favorable things to say about Aetna when it comes to the payment department. > > Plus since Medicaid made my daughter her 'head of case' (even though I included the guardianship papers with the Medicaid application), I now have to go through the hassle of having that changed before I can make changes with the Integrated Care Program. > > > Story #4 > > > I received this packet of information in the mail. Today I called to find out what it is all about. I have three children with intellectual disabilities and my oldest is Rick. He is 20 and has Down syndrome. He is moderately involved. At 18 we had to switch from his pediatrician to a general practitioner for adults. Well, let me tell you, that did not go over well. > > I made my call today to find out more about this program. The nice young lady did my intake and then asked about his doctor. I informed her who my son's doctor is and that he is with Loyola Hospital. Of course, that is not on either program. I explained our situation; that my son will not see any other doctor and that it is important he stay with Loyola since all of his specialist are practicing out of Loyola Hospital. She will send a note to the doctor to see if he is willing to accept either of the programs. > > They seemed nice enough, but what are families who have VERY involved loved ones going to do? I'm upset about my own son, but I immediately thought about the families with more involved children; all the medical records, comfort levels etc. > Something is not right about this whole program. > > > > Story #5 > > Hi all: > We just had our first experience with Integrated Care...I was told that Noah needed vision testing annually as part of his ISP. There is a group called March Vision Care that signed on to Aetna Better Health. When I called, I was given the closest providers, one of which was about 10 minutes away...Rosin EyeCare Glenview (there are a number of Rosin Eyecare offices, and, I think, all are part of this.) The O.D., Bechtold was very nice to Noah and the exam was quite thorough. Office staff were also very nice. This particular office is located at 1346 Patriot Blvd, Glenview, 847-729-5050... > I am now waiting to see if Aetna pays...I asked the office staff to be sure to let me know if there is any problem. > > > > STORY #6 > > Yes I would love the name of any of the good docs you have found. Like I said, I contacted Aetna and did the HFS on line search and NOTHING came up in the suburban area -even if I didn't specify a particular specialty of service. This is so much worse than Bad Medicaid. It will force us to abuse the system and go to the hospital for care just like smart insured people are not supposed to do. I think I will be very happy if the Walgreen Take Care Clinic or CVS will take this Insurance to tell you the truth- it's convenient when you are sick and they care so much about you when there are Nurse Practitioners - unlike our state - > > Story #7 > > > > This is just more and more frustrating. Today, I found out that some secondary/backup physicians who Bill has seen that ARE listed with Aetna on their website are listed because they take the Aetna INSURANCE. NOT this new ICP stuff. So a physician's name listed on the companies websites is NOT a guarantee they are in the program, as discussed in the letters I've been receiving. So company websites are no good. > > So I called the help number -- of course she won't talk to me without my faxing the guardianship papers (SO GLAD I filed for those) and waiting for a call back from the office sometime tomorrow or the next day before anyone will talk to me about anything. Instead, she directed me to <http://www.illinoiscebICP.com> www.illinoiscebICP.com So the help phone number is no good. > > So I went to www.illinoiscebICP.com NOTHING. First they wanted all Bill's numbers (SSN and Medicaid) on a NONSECURED site (WHAT????) before I could even search. So I crossed my fingers, listed the numbers, misspelled our family name as the state has done for 6 years, and was then allowed to search. again NOTHING in our zip code, NOTHING in our county. I tried multiple searches, multiple combinations, added, deleted criteria. Always NOTHING!!!! So the ICP web site is no good. > > When I asked Bill's doctor what his advice was since I'm not finding any PCPs in this town, or the next towns, I was advised " take him to the ER, they'll treat him there " . So we have to use the ER for routine medical care?? This is supposed to be cost-savings???????? > > And now I find I have no card for June -- his card expires today. Is the state not sending out the old cards for June? > > PLEASE HELP!!!!!!! > > One very frustrated Mother / guardian / POA > > Story # 8 > > The choices for PCPs are pathetic. I can't even pronounce the names of the doctors, nor can I determine their gender by looking at their names. My daughter (autistic) does not like to be examined by a male doctor. There are no female doctors listed. > > >Angel's next session with her psychiatrist is June 8th. She's been with Loyola for behavioral health for six years now. As long as she is on these dangerous meds, I have no intention of experimenting with a 'new' doctor from that pathetic list. I will ask her doctor for instructions on weaning her off the meds. For regular medical care, I'll take her to the ER. Screw this freakin state. The most vulnerable of its citizens, older adults and adults with disabilities have been banished to this horrible program. The parasites still get the free ride. > > >I just hope that my husband gets this new job and we can put Angel on the insurance. > > >Does anyone know the bill number where this horrible program was passed? I want to get a list of the representatives and state senators who voted for it, because I intend to use the internet to convince their constituents to vote for someone else. A dog could do a better job in Springfield. > > Story #9 > > I feel the same way. I too would like to know who's behind this > thoughtless piece of legislation. My daughters long time medication has now > been changed and I found this out when I went to pick up her meds at the > pharmacy and our new doctor is a half hour away and is located in a > Walmart. > I will be the voice for my daughter; this is not right. > > > > From: IPADDUnite [mailto:IPADDUnite ] On Behalf Of Bonnie Dohogne > Sent: Wednesday, June 08, 2011 3:28 PM > IPADDUnite > Subject: Re: Re: Integrated Care Program > > > > > > Hi , > I've been gone for 3 weeks and see there are many emails on the integrated care > program to catch up on. Thank for your willingness to compile stories about > issues with this pilot. > > My state representative is highly skeptical of managed care organizations, > having had years of experience with them through an advocacy group. She asked > for feedback on this pilot, so I'll be very glad to pass it on. And I hope > others on IPADD will also share the information with their state representatives > and, of course, to Hamos. > > Medicaid and public employee pensions are the two biggest parts of Illinois' > budget. Given the continuing bad budget situation, it seems inevitable that > legislators will work for Medicaid " reform. " I think we must let them know how > it impacts our families. > > Thanks again. > > Bonnie Dohogne > > ________________________________ > > > > > > Quote Link to comment Share on other sites More sharing options...
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