Healthcare coalition gives call to action to residents regarding Medicare Advantage in-network coverage

Published 5:31 am Thursday, January 27, 2022

By Alex Guerrero

The Albert Lea Healthcare Coalition is urging residents with Blue Cross Blue Shield’s Medicare Advantage plan to request the insurance company expand its in-network coverage for area residents to include the new MercyOne Albert Lea Family Medicine & Specialty Care clinic.

The coalition had a meeting Tuesday night to discuss a number of topics, chief among them the availability (or lack thereof) of coverage involving Blue Cross’ Medicare Advantage program, and an agreement that didn’t happen by the Dec. 7 deadline. 

The Medicare Advantage program is the only Blue Cross program not in-network at the new MercyOne clinic.

“What we want to do is we want to inform [people] and then we want them to go out and call Blue Cross,” said Brad Arends, president of the coalition. “We want them to call their representatives and say, ‘We need this to change.’”

Arends said they were notified in early December the specific insurance plan wouldn’t be offered because of a contractual provision stating only Mayo Clinic would be in-network for that plan. According to Arends, Mayo Clinic and Blue Cross Blue Shield essentially have a private contract.

“When that contract comes up again, we need to make sure (the Mercy) clinic can be deemed in-network for that Medicare Advantage program because it’s the most popular plan in southern Minnesota today for our seniors,” he said.

Rod Schlader, CFO of MercyOne North Iowa, expressed disappointment with what happened and said Blue Cross wasn’t transparent in their negotiations.

“I’ve been in this business a long time, probably over 30 years, and I’ve never seen a Blue Cross product that had a narrow network product like this in Iowa … and Illinois…,” he said. “The Blue Cross products usually want to be collaborative with all of the providers in the area.”

He said part of the reason for having a narrow network product is to help control product cost and reduce prices for beneficiaries. He admitted to not knowing if Mayo was the driving force for the out-of-network insurance plan.

“MercyOne Albert Lea is in-network if you live in Burnsville, so the people in Burnsville can travel down here and MercyOne is in-network…,” said Craig Ludtke, an Albert Lea Healthcare Coalition trustee, who spoke on different insurance options. “If you live here in Albert Lea you cannot [see a doctor at the clinic with a Blue Cross Blue Shield Medicare Advantage program].”

That’s not to say MercyOne didn’t try to get in-network.

“MercyOne did everything they could,” he said. “Between MercyOne and Albert Lea Healthcare Coalition, we have talked to Blue Cross Blue Shield for a year, and all the filings that MercyOne did were all complete. We got acknowledged they had it and that they were looking at it and that we would potentially have clearance for Albert Lea to be in-network in Freeborn County.”

He also noted the same Blue Cross Advantage plans are more expensive here than for a person in the Twin Cities. 

“In the metro area, the cost is $78.70/month, and your out-of-pocket max is worth $3,000 in-network…,” he said, referring to Blue Cross Blue Shield. “In the west regions, … the cost for Medicare plan is $87.40/month and out-of-pocket maxs are the same as the metro area.”

In the south region, that same coverage is $125.90/month. And within Freeborn County, the only choice for an in-network provider is Mayo.

District 27 Sen. Gene Dornick and District 27A Rep. Peggy Bennett were also on hand at the event.

“This is not a legislative issue per say because there’s no law that’s stopping Blue Cross from having MercyOne in-network and adding that to Mayo or flip-flopping or whatever they want to do,” Bennett said.

According to Bennett, back in 2018 Blue Cross approached Mayo Clinic to develop a network, otherwise referred to as accountable care organizations.

“It’s very common for insurance companies to create networks of service,” she said. “That’s why we have things that are in-network and out-of-network.”

Mayo and Blue Cross’ current contract runs through 2023, though it can be re-opened (though such practices aren’t common).  

“We’re looking to contact the Minnesota Attorney General,” Ludtke said.

In other news:

  • Arends said there was still room for expansion in the 64,000-square-foot facility. Currently, MercyOne is building an almost 1,000-square-foot medical equipment facility, though construction is delayed. A completion date is set for March.
  • Currently the clinic has specialists in ear, nose and throat, cardiology, urology, neurology, sleep medicine and orthopedics.
  • Coalition Trustee Jill Morstad reported there were currently 20 employees at the clinic with two physicians. There were two nurse practitioners and a physician associate. Starting in March the clinic will have specialists in dermatology, podiatry, weight management and plastics.  
  • Tom Sullivan from Big Stone Therapies announced a free screening process next Monday.
  • Stewart Trembath, an owner of Hearing Associates, said the MercyOne clinic was the second-largest of the nine Hearing Associates clinics. Currently there is one provider who works three days/week, but he wants to expand that to five days/week. 
  • Coalition Trustee Steve Tufte, giving a report on the worksite clinics, announced his company — Innovance — and their 1,100 employees transitioned over to the MercyOne clinic.

For anyone wishing to switch health care plans, there is an open-enrollment period from Jan. 1-Mar. 31. If you decide to switch plans, the new insurance won’t be effective until the first day of the month after approval.

Above all, Ludtke wants people to raise their voices.

“We think if we send enough letters to Blue Cross Blue Shield, what counts with these people is numbers,” he said. “If they think that they’re going to lose 200 or 300 seniors, then maybe it matters. If they think they’re going to lose one or two, I don’t think they care.”

Members of the coalition urged attendees to write letters and send consumer-complaint forms to the attorney general.

“Contact them,” Arends said. “Don’t get on the phone and yell at them. That doesn’t help.”

The Minnesota Attorney General Consumer Assistance Request Form is available at https://www.ag.state.mn.us/Office/Forms/ConsumerAssistanceRequest.asp. You can also find contact information on the Facebook page of Albert Lea Healthcare Coalition under the media tab.