GM retirees face health insurance adjustment
JANESVILLE — Paying for 20 percent of a routine office visit at Dean Clinic-Janesville East is one thing.
Reaching into your pocket to pay 20 percent of an expensive procedure at the neighboring St. Mary's Janesville Hospital is quite another.
That will soon become a consideration for local General Motors' retirees.
Since 2008, Dean and St. Mary's Hospital in Madison have been non-participating health systems in the Medicare supplement offered GM retirees through the UAW Retiree Medical Benefits Trust.
The trust provides health care benefits for more than 860,000 retired UAW members of General Motors, Ford and Chrysler and their eligible dependents.
Launched in January 2010, the trust is a result of the 2007 collective bargaining agreements that transferred all retiree health care liabilities to an independent, voluntary, employee beneficiary association. Although the trust administers the health care plans covering retirees from all three auto companies, there is a separate trust fund that pays benefits for retirees from each auto company.
Effective Jan. 1, the trust will not provide coverage for elective services at non-participating providers.
While Dean and St. Mary's are still on that list, there's a twist for local retirees to consider: St. Mary's Janesville Hospital will open on Jan. 9, and that's where Dean physicians will treat their hospitalized patients.
In the past, the trust paid for the services and procedures for Dean patients at Mercy Hospital and Trauma Center, which is a covered provider.
With the opening of the new St. Mary's hospital, however, the trust will not cover services there because it is a non-participant.
That doesn't mean retirees can't continue to visit Dean or St. Mary's. If they do, however, they will continue to pay what Medicare doesn't cover.
"The real change is with the opening of the new hospital," said Diane Wilhelm, Dean's clinic administrator for Janesville, Delavan and Stoughton. "Mercy, which is an in-network hospital, was the only hospital in town. Our procedures will now be done at the new St. Mary's instead of at Mercy."
The trust has sent mailings to retirees notifying them of the change. Union benefit representatives also met with retirees to explain what will happen with the opening of the new hospital.
But many remain unaware of the change and its implications, said Joan Wilson, the spouse of a local GM retiree.
"People need to be aware of this change," Wilson said, noting that information and mailings talk about "non-participating" providers but do not mention the providers specifically.
Wilson said she and her husband have expensive health issues, but they've decided to stay with Dean and St. Mary's.
"It's because we have a lot of trust and confidence with Dean and St. Mary's," she said. "We like Mercy, and we've been there several times, but we just want to stay with what we've had."
To do that, the Wilsons have signed up for DeanCare Gold, a Medicare insurance plan that will cover their costs for Dean and St. Mary's services.
Wilson said the third layer of coverage—behind Medicare and the UAW trust—will cost the couple an additional $2,500, but she said it allows them to stay with their doctors and avoid paying 20 percent of an expensive hospital procedure.
Wilhelm said local demand has been high among retirees for the DeanCare product. In fact, representatives are planning more informational meetings in Janesville.
In addition, she said, Dean has been calling local retirees who have procedures scheduled at the new hospital to make sure they understand that their insurance will treat the procedure differently than if it had been done at Mercy.
"We want to make absolutely sure they understand the change so that there are no surprises," Wilhelm said.
Mar 16, 2012 at 6:59 p.m.
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I heard that our politicians get great healthcare benefits. And after 4 years, their whole family gets great healthcare benefits too for life. Is this true? We are paying for all of this and yet we get crap.
Dec 30, 2011 at 12:48 a.m.
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Um yeah poobah. Guess you just gotta visit some of them. I don't know what else to say other than the standard of care is nowhere near the private sector. Notice the source on your citation? Where did it come from? Conflict of interest? You be the judge. To say VA healthcare system is anything resembling a model is a hoot.
Dec 29, 2011 at 10:30 p.m.
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Nota...I have United Health Care and St Mary's is in my network.
Dec 29, 2011 at 5:46 p.m.
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Why hasn't anyone asked this question of Dean-St. Mary's - Why are you not in network for any insurance other than DeanCare? They are not in network for any of the large insurance carriers including Blue Cross, United Health Care and Humana. It will be interesting to see whether they will actually get enough business here in Janesville without being in network for anyone other than DeanCare. Frankly the DeanCare network is pretty small, considering everything. I think that it is important to pick the plan with the greatest amount of CHOICE.
Dec 29, 2011 at 4:46 p.m.
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jv93, no, I have not been a patient at a VA hospital. My grandfather, father and two uncles have been patients at VA hospitals and they were very pleased with the care they received.
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Time Magazine
How Veterans' Hospitals Became the Best in Health Care
By DOUGLAS WALLER Sunday, Aug. 27, 2006
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http://www.time.com/time/magazine/articl...
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Health Care Superv. 1994 Mar;12(3):44-50.
Patient satisfaction in VA medical centers and private sector hospitals: a comparison.
Rollins RJ.
Source: Veterans Affairs Medical Center, Tuskegee, AL.
Abstract: For the first time, we have data that can validly compare the satisfaction level of inpatients in Department of Veterans Affairs (VA) medical centers and private sector hospitals. It shows the satisfaction levels to be very similar.
Dec 29, 2011 at 4:26 p.m.
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I assure you poobah, care at any VA hospital is nothing to brag about. Ever been in one?
Dec 29, 2011 at 4:14 p.m.
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BillyClydePuckett said, "Regardless of the cost, regardless of the ability of the taxpayer to fund it, free healthcare for life is a basic right for that group."
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Or join the military for one tour and get free national, single payer healthcare for life. This wouldn't be an issue if we expanded the VA healthcare system to all citizens, eliminated Medicare, Medicaid, all state healthcare programs and private insurance from the equation. We'd surely move up from our World Health Organization healthcare ranking of #37 in the world.
Dec 29, 2011 at 2:03 p.m.
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curly~ understood! I did the GM thing and woke up before the ship sank. I just looked in the right places. That should give you and everyone else hope. Stop listening to "the sky is falling" garbage that everyone around you is telling you and move on. I mean that respectfully.
Dec 29, 2011 at 1:40 p.m.
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kleej - "Here's the solution for people, put yourself in a position where the money side of things is no longer an issue. It actually works!"
Yes that would work - but only IF you can find a job in WI that pays a wage that allows you to have money to save.
Dec 29, 2011 at 1:37 p.m.
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kc- did you walk around asking everyone if they are GM retirees? GM retirees don't have a stamp on their foreheads so how would you know where they worked? Don't know if you understand how many retired people live in Janesville? Did they ALL work at GM or perhaps the elderly of Janesville want to change their medicare supplement for better coverage.
Dec 29, 2011 at 12:39 p.m.
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I notice that Dean is calling retirees with " procedures scheduled at the new hospital to make sure they understand that their insurance will treat the procedure differently than if it had been done at Mercy." WOW! This is customer service that I wouldn't normally expect. Way to go Dean!
Dec 29, 2011 at 12:35 p.m.
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More CHANGE? It's called LIFE. Here's the solution for people, put yourself in a position where the money side of things is no longer an issue. It actually works! ;)
Dec 29, 2011 at 11:16 a.m.
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Why do they run stories/events like these?
For the want of pity?
Dec 29, 2011 at 10:21 a.m.
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Wish you could have seen all of the GM retirees packed into Riverview Clinics lobby this morning waiting to sign up for Dean Insurances Medicare Replacement policy, DeanGold, or the Medicare supplement policy, Dean Senior Select.
hmmm, what does that tell you?
Dec 29, 2011 at 9:56 a.m.
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Simply a case of anyone who worked for GM making a poor choice. They should have taken a job with the local, state or federal government. Regardless of the cost, regardless of the ability of the taxpayer to fund it, free healthcare for life is a basic right for that group.
Dec 29, 2011 at 9:15 a.m.
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The union reps are not in this week as they are mostly on a paid lavish vacation somewhere warm that was comped by Your union dues.
Dec 29, 2011 at 9:07 a.m.
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Hey ruthdenny, good comment. The best thing that could happen is to have the UAW hall closed forever. What good have they ever done ?
Dec 29, 2011 at 8:43 a.m.
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No Fedup it will be Bush's fault this time around!
Dec 29, 2011 at 7:35 a.m.
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Can't wait to read how this is somehow Walker's fault.
Dec 29, 2011 at 1:26 a.m.
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AWWWWWW, that just breaks my heart. Interesting there are very few comments on this one.
Dec 28, 2011 at 9:06 p.m.
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The article should have been more specific and noted that all GM Retirees do not receive government supplied medicare supplemental insurance - UAW only. Make no mistake that the coverage that UAW retirees receive without premium is paid for by the taxpayer as part of the bailout. Except for the UAW and government employees, most everyone else in town has long paid their own way.
Dec 28, 2011 at 7:12 p.m.
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Call your insurance company direct. They will explain what they cover and don't cover. You don't need union personel to answer insurance questions.
Dec 28, 2011 at 6:42 p.m.
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Really nice that UAW hall is closed this week when we can not get info on our insurance. No one to talk to. Must all be more important to get recall signatures.
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