Is Alexian Brothers in Land of Lincoln’s network? Alexian has no idea

Jan. 25--There is more confusion over Land of Lincoln Health's network of hospitals and doctors.

Alexian Brothers Health Systems in the northwest suburbs confirmed Monday that negotiations over a new contract with Land of Lincoln broke down at the end of last year over reimbursement rates. But a hospital executive said he is "in the dark" about Alexian Brothers' network status.

Alexian Brothers is at least the second Chicago-area health system to have a contract dispute with Land of Lincoln in recent weeks.

The Tribune first reported last week that the insurance company will remove the University of Chicago's medical center and physicians group from its network after the two sides couldn't reach an agreement on rates. Land of Lincoln customers who had purchased a plan through the federal insurance exchange or through a broker have complained that the insurance company falsely advertised the university's inclusion in the network during open enrollment in November and December.

"LLH is constantly working to expand its network of providers and also keep premiums competitive," said Dennis O'Sullivan, Land of Lincoln's spokesman. "As a result, networks can sometimes change as health care provider contracts are constantly being negotiated for the most competitive rates for services provided."

Doctors and hospitals have to provide discounts for their services to be included in an insurance company's network. Medical plans give consumers financial incentives to go to "in-network" providers by covering a higher percentage of charges. If consumers go outside the network, they face significantly higher health care costs.

Land of Lincoln wanted Alexian Brothers to join a health plan that the insurer had started last year with Adventist Midwest Health in the western suburbs, said Robert Wright, vice president of managed care contracting at Alexian Brothers. Adventist Midwest formed a joint venture last year with Alexian Brothers called Amita Health.

The Adventist health plan offered consumers cheaper premiums than Land of Lincoln's traditional PPO. Consumers also were offered financial incentives to seek care with one of Adventist's hospitals and physicians but retained the choice to go outside the system to a provider in Land of Lincoln's broad PPO network. The insurer also provided some minimal coverage outside its PPO network, giving consumers three levels of coverage.

To join the Adventist plan, Land of Lincoln asked Alexian Brothers to take a significant cut in reimbursement rates, Wright said. Alexian Brothers has five hospitals in Elk Grove Village and Hoffman Estates and about 260 employed physicians.

Wright said Land of Lincoln's negotiators told him that the cuts were needed for the insurer to survive. The insurer is one of 23 carriers created by the Affordable Care Act to offer lower prices and compete with large insurers like the Blue Cross and Blue Shield affiliates. The startups are facing financial difficulties after some promised federal aid did not come through. Twelve have shut down or announced their closures.

But Wright said the cuts were not acceptable. He said he came back with a counteroffer but never heard back from Land of Lincoln.

Nevertheless, he said he thought Alexian Brothers, heading into 2016, remained in the insurer's PPO network. But a check of Land of Lincoln's website Friday by the Tribune indicated that Alexian Brothers was not in the network.

That came as a surprise to Wright. Alexian Brothers spokesman Matt Wakely sent the Tribune a screen shot from Land of Lincoln's website dated Jan. 4. It says that Alexian Brothers is "still part of our 'In-Network' Providers."

"I'm confused here," Wright said Monday. "I'm not sure how we are going to serve our patients."

Wright said he has not received a termination notice from Land of Lincoln, and he described the company's conduct as "extremely unusual."

"I'm obviously going to have a frank phone call with Land of Lincoln," Wright said.

Further complicating the saga is that Land of Lincoln relies on an outside company, Private Health Care Systems (PHCS), for part of its provider network. Alexian Brothers was in Land of Lincoln's network through PHCS, and Wright said he still has a contract with PHCS.

O'Sullivan said the company has always planned to rely less on its rental network with PHCS and contract directly with hospitals and physicians. He suggested that members visit the company's website to learn more about its provider network.

Until Alexian Brothers receives more clarity about its network status, Wright said patients with a condition that requires ongoing care should contact the health system at 847-385-7193.

"To offer the preferred rates, it will require the cooperation of Land of Lincoln to adjudicate these claims as in-network," Wright said.

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