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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?

>

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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

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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

>

>

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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

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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

>

>

>

>

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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@...

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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@...

>

>

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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@...

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  • 3 weeks later...
Guest guest

, 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

>

> ________________________________

>

>

>

>

>

>

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