SUAA Identifies (Limited) Path to Mayo Clinic for Current Retirees on TRAIL

Have you experienced a serious health diagnosis and desired a second opinion from a specialist or other world-renowned provider? Only to discover that your CVS/Aetna Medicare Advantage plan says you can’t? This situation should never exist and is a story that should never need be told. Unfortunately, SUAA retiree-members have experienced this outright refusal to receive medical care at the Mayo Clinic many times. The Illinois Department of Central Management Services (CMS) has shared with us that this is one of the most common complaints they receive in the office. SUAA can now provide a little hope when these situations occur. A limited path has been identified for you to receive desired care at The Mayo Clinic. Although this path is not yet well-paved or travelled, it represents much needed progress.

In a recent meeting hosted by SUAA and State Representative Natalie Manley (D-Romeoville), the Department of Central Management Services explained some of the nuances of the situation and provided guidance for how you can create a “single case agreement” with Mayo Clinic to obtain care. The first step is to contact CVS/Aetna directly to be assigned a case manager. Working with your assigned case manager, and sometimes your physician too, you will work to put together a single case agreement to move forward. If you experience any difficulty in moving through the process, please feel free to call SUAA, or skip the middleman and go straight to CMS with your question. CMS has a CVS/Aetna representative in their offices able to answer your questions. Those with questions may call the CMS at 1-800-442-1300 and, if needed, will be connected to the CVS/Aetna representative.

PLEASE BE AWARE: The information shared indicates that the situation members are experiencing with the Mayo Clinic has more to do with the failure of Medicare Advantage (MA) programs nationally than it does with CVS/Aetna or CMS. In 2023, nearly 1 in 5 health systems stopped accepting one or more MA plans. SUAA’s position is that a “one size fits all” approach to healthcare for state retirees is naïve in today’s marketplace. Seemingly every year, several hospitals throughout the state consider dropping the plan, causing anxiety among our members and other retirees, only for an 11th-hour agreement before expiration, imposing uncertainty and stress on the served population.

Illinois’ current contract with CVS/Aetna MA plan is slated to run until 12/31/2027, at which time there is a possibility of auto-renewal for an additional 5, one (1) year periods. SUAA will continue to keep you informed as this and other issues develop and will always fight for our members to fight for full pension funding, improved Tier II benefits, and better medical coverage.