Children's hospital working with families following exchange exits, co-op closure | Courtesy of Shutterstock
+ Regulatory
John Breslin | Dec 19, 2016

Children's hospital working with families following exchange exits, co-op closure

A downtown Chicago children’s hospital is working with families to try and ensure that patients who need treatment are still able to receive it at the facility, following the exit from the individual marketplace of three insurance companies -- and the collapse of a fourth.

None of the insurance companies continuing to provide plans on the exchange include Lurie Children’s Hospital as an in-network choice.

Lurie is among a number of leading hospitals in Chicago not included in any exchange plan offered in the state.

Others include University of Chicago Medicine, Rush University Medical Center and Northwestern Memorial Hospital.

The hospital has issued advice to families worried about the continuing care of their children.

“We are working closely with families that still need to be seen at Lurie Children’s,” Communications Director Julie Pesch told Patient Daily. “The 200 Lurie patients who were covered by an insurer no longer on the exchange -- yet have appointments booked for treatments like chemotherapy -- we are negotiating rates with insurers and working with state regulators to figure out how the patients' parents can pay for their treatment.”

Coventry, a division of Aetna, announced in August it was pulling out of the Illinois-based exchange. Two United Health Care subsidiaries, Harken and United Compass, followed with the same announcement in September.

“For those families who can receive care elsewhere, we are assisting them in finding the right coverage,” Pesch said.

While none of the companies explicitly stated the reason for pulling out, financial losses are cited by others as the catalyst.

Land of Lincoln, a nonprofit consumer oriented and operated plans (co-op), closed its doors in July after the Illinois Director of Insurance ruled it was no longer a viable operation.

The remaining five exchange plans all have narrow networks that do not include the storied children’s hospital, which is recognized as one of the top pediatric facilities in the Midwest.

Families with patients previously cared for at Lurie are advised to check whether they can get coverage through an employer -- or whether the child qualifies under the Medicaid All Kids program.

“If you choose an exchange plan, you will need a prior authorization of services from that plan,” the hospital stated in a note on its website. “Without a prior authorization, your child’s care at Lurie Children’s would be out of network. This means that it is very likely you will be responsible for most or all of the costs.”

Sabrina Corlette, of Georgetown University’s Center on Health Insurance Reform, said it is common across the country to see academic medical centers left out of exchange plans. Exchange shoppers tend to be very price-conscious, so insurers are trying to keep premiums for those plans low, Corlette told the Chicago Tribune in an October interview.

One way to do that is by excluding higher-charging academic medical centers. Patients who need a medical center for a specific service or specialist can ask insurers to make an exception, or they can go to their state department of insurance to compel coverage in some cases, Corlette told the Tribune.

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