MDH Update with Aetna Insurance

November 30, 2022

McDonough District Hospital is currently awaiting an official response from Aetna in relation to the commercial insurance plan.

As for the Medicare Advantage plan - Information from a Trails document sent to State of Illinois retirees indicates that Aetna MAPD PPO Plan participants, as of January 1, 2023, will “be able to use any doctor, hospital, or specialist in or out of the Aetna Medicare Advantage network without paying more for out-of-network services, as long as the provider has accepted the plan and has not opted out or been excluded from Medicare.”

MDH and its providers accept Medicare and will file insurance claims with Aetna, therefore individuals with Medicare Advantage can stay with McDonough District Hospital.

When there is an update on the commercial insurance plan MDH will notify the public.

For a full list of insurance plans accepted please refer to the Pricing Transparency at McDonough District Hospital document, located on the Financial Services webpage at MDH.org under Patients & Visitors.

November 17, 2022

McDonough District Hospital is actively negotiating with Aetna in relation to its Medicare and commercial insurance plans.

Information from a Trails document sent to State of Illinois retirees indicates that Aetna MAPD PPO Plan participants, as of January 1, 2023, will “be able to use any doctor, hospital, or specialist in or out of the Aetna Medicare Advantage network without paying more for out-of-network services, as long as the provider has accepted the plan and has not opted out or been excluded from Medicare.”

MDH and its providers accept Medicare and will file insurance claims with Aetna, thereby accepting the plan.

Although no contract currently exists between Aetna and McDonough District Hospital and its providers, MDH will continue with negotiations.

We will continue to communicate any news updates to the public as necessary in advance of the November 30 deadline.

Thank you for your patience and understanding.

November 4, 2022

The state of Illinois announced a change in insurance providers for retired individuals – including a group of retirees from Western Illinois University. The state is moving to Aetna insurance.

A brief history covering McDonough District Hospital’s relationship with Aetna insurance.

Five years ago in May, McDonough District Hospital was not notified by the state of Illinois or Aetna on any insurance changes until after open enrollment began. MDH sent a Letter of Agreement to Aetna with a commercial insurance proposal for state of Illinois participants. The letter covered typical medical costs and percentage discounts, at the same competitive pricing structure that was in place with Cigna. Over the next six months, MDH went back-and-forth with Aetna during the negotiation process. In December, MDH submitted to Aetna yet another proposal. Two weeks later Aetna stated it would not be able to meet the suggested pricing and went away from the negotiating table.

Currently, MDH is working on a Letter of Agreement with Aetna for Medicare Advantage insurance, allowing all state retirees to keep MDH within their primary network. During this process Aetna is attempting to negotiate its commercial insurance program with MDH as part of a package agreement. Once again – just like five years ago – the pricing and discount terms were not sustainable for your community hospital.

As a hospital but also a business, we work towards contract parity. As we learned five years ago, it’s difficult to come to a partnership agreement when the other party hesitates to budge on its reimbursement pricing. MDH is not aware of what agreements are in place with Aetna and other healthcare facilities due to confidentiality.

MDH’s priority is to reach an agreement with Aetna on its Medicare Advantage plan, and we are optimistic an agreement can be reached. If we reach acceptable terms for Aetna’s commercial package then we will strongly consider adding it as another insurance option.

We are aware the deadline to sign up for Aetna’s plan is quickly approaching (December 1). Once we have an update to announce, we will share that information.

The Hospital’s leadership must make decisions that focus on quality patient care, yet still be fiscally sound, to ensure MDH will be serving west-central Illinois long into the future. You have entrusted us with you and your family’s health; we recognize that and are honored to serve you.

We want to continue to be Your Community Healthcare Partner.

Thank you for your patience and understanding.