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By Alex Guerrero

When Mayo Clinic Health System packed up and moved some of its services from the city, many local residents were not happy. 

So when the new MercyOne Albert Lea Family Medicine & Specialty Care opened earlier this year, these same residents were thrilled — at least until they found out MercyOne wasn’t in their in-network health insurance coverage. 

That’s not to say the new clinic can’t find insurance providers. All of the major providers in the state have included MercyOne in-network for corporate health insurance. 

But for those with Medicare, particularly Blue Cross Medicare Advantage, not being covered is a problem.

Brad Arends is the president of the Albert Lea Health Care Coalition, which was formed after Mayo announced plans to remove services from Mayo in Albert Lea, including intensive care, overnight stays and birthing. He and others helped recruit MercyOne to town.

“That is the most popular Medicare Advantage plan in southern Minnesota,” Arends said. “It’s southeastern and south-central Minnesota, the only provider of care in that product is Mayo Clinic.” 

That has left local residents in limbo.

“I believe with how Albert Lea and Austin were set up by Mayo — and I think with state licensure — I believe that Albert Lea and Austin were considered to be one campus,” said Mike Petersen, a local health insurance specialist through Heartman Insurance.

That decision made it easier for Mayo to reposition some services out of the community without violating licensure terms, Petersen said.

Some residents want to persuade Blue Cross into expanding its in-network coverage to MercyOne, or simply find a new insurance provider.

Petersen said a new provider would control costs and keep premiums lower. He would like to have both the new MercyOne and Mayo services in-network.

“Rural health care is challenging because a lot of the write-offs, things like that,” he said. 

He emphasized agents are not part of the process of determining coverage and costs. Instead, those rates are set by lawyers negotiating a price.

He gave the example of a young family with children.

“Having to drive, call it a 45-minute round trip, can be extremely challenging with either work hours, day care or anything,” he said.

Another reason for the new clinic is an older clientele in need of transportation. And it’s his hope that more competition will bring more health care options.

District 27 A Rep. Peggy Bennett plans to call legislators for Blue Cross to discuss why residents had to travel to Iowa to get medication and procedures in-network.

“Regular Blue Cross insurance does cover the MercyOne clinic, but the Blue Cross Medicare Plan B … is not in-network,” she said.

She said she plans to ask these questions to figure out how she can help fix the problem.

Bennett stressed the need to rework agreements between insurance providers and hospitals to ensure local health providers were in-network, especially considering the larger older population in the area.

“Those people shouldn’t have to travel to Mason City to get their care just because for some reason they’re not in-network in Minnesota,” she said.

Bennett would like to address the insurance problem sooner than later, ideally by the end of the next legislative session in May. 

“I look forward to talking with Blue Cross to find out what the issue is, and let’s get it fixed,” she said.  

“Our seniors are upset because … Blue Cross is not contracting with our clinic to be in-network for Blue Cross’ Medicare Advantage program,” Arends said.

Complicating issues more is a contract between Blue Cross and Mayo, which says Mayo will be the only provider of Medicare Advantage for southeastern and south-central Minnesota. 

“Our citizens are impacted by that because there’s effectively a monopoly that nobody else can get in to provide services for that Medicare, for that Blue Cross Medicare Advantage program,” Arends said.

And while other carriers do provide that program, they’re either more expensive or provide inferior coverage. Currently the only way to get in-network for MercyOne is to drive to Mason City. 

In the meantime, Arends encouraged concerned residents to contact Gov. Tim Walz and other state representatives and encourage them to step in.  

“When you really think of who we’re talking about, it’s senior citizens here, many of whom are on a fixed budget in retirement,” he said. “This is putting them from a financial standpoint that, quite frankly, can’t afford to be in that position. They need certainty.”

A call to Blue Cross was not immediately returned.