After two years of financial and emotional stress for thousands of central
Illinois patients, those covered by Blue
Cross and Blue Shield of Illinois regained in-network
access to Springfield
Clinic medical providers on Jan. 1.
Chicago-based Blue Cross and the clinic issued
statements Dec. 22 that they have reached a new five-year agreement allowing
the clinic to return to in-network status.
The 56-year-old Springfield resident decided to
pay more than $1,000 in out-of-pocket charges so she could keep seeing two
clinic doctors – her family physician and obstetrician-gynecologist – even
after they became out-of-network providers in her employer’s Blue Cross plan.
“I’m over-the-moon happy about it,”
she told Illinois Times. “It’s going to save me money in the long
run, and I can use my insurance as it’s supposed to be used.”
A contract dispute prompted Blue Cross to remove
the clinic and its 400 physicians and 300 advanced-practice registered nurses
and physician assistants from Blue Cross’ preferred-provider network in
November 2021.
The for-profit clinic estimated at the time that
Blue Cross’ decision would affect 100,000 clinic patients throughout central
Illinois, while Blue Cross officials said the correct number was not more than
55,000.
Neither side revealed details of the new
contract or what led to a resolution of the dispute. Springfield Clinic
wouldn’t say how the dispute affected the overall number of patients using the
clinic.
McEvoy, an administrative assistant at Hanson
Professional Services Inc., said she always held out hope that the clinic would
return to in-network status. She doesn’t care how the two sides worked out a
deal.
“You don’t need to know how the sausage is
made,” she said. “Overall, it’s a benefit for all of Springfield and the
surrounding communities.”
The saga included months of testy statements
from each side directed at the other.
Blue Cross publicly complained that the clinic
was demanding a 75% increase in rates even though the clinic’s rates were
already the highest in the Springfield markets and 60% more than those in the
Chicago area. Blue Cross said giving in to the clinic’s demands would
result in Springfield-area small businesses that are Blue Cross customers
picking up the slack and seeing increases of up to 30% in their premiums.
Clinic officials never responded directly to Blue
Cross’ assertions.
But in letters to patients in 2021, the clinic –
which operates medical practices in Springfield and in communities that include
Carlinville, Jacksonville, Lincoln, Sherman and Taylorville – criticized Blue
Cross’ stance in contract negotiations and implied the company was greedy.
Clinic officials noted at the time that Blue
Cross’ parent company, Chicago-based Health Care Service Corp., was earning
record profits during the COVID-19 pandemic.
Blue Cross, like many insurers nationwide,
benefited financially because premiums continued to be paid by employers and
workers while many patients delayed or avoided health care services for fear of
being infected by the novel coronavirus.
“At a time when countless individuals, families
and businesses in our communities have faced financial challenges and hardships,
it is unimaginable that BCBSIL would terminate Springfield Clinic as an
in-network provider," the letter to patients said.
The situation led to surges of patients seeking
care at physician groups that remained in the Blue Cross network, such as those
at Southern Illinois University School of Medicine and Memorial Health.
Patients sometimes faced long waits for non-emergency care as they tried to
avoid hefty out-of-pocket charges for remaining with their longtime Springfield
Clinic providers.
Some employers that had contracted with Blue
Cross switched to other insurers so their employees could retain in-network
access to Springfield Clinic.
The General Assembly became involved, too, as it
considered whether more regulation of health insurance companies was warranted.
No action was taken, but more debate is expected in the Legislature’s spring
2024 session.
The rift between the clinic and Blue Cross, the
state’s largest health insurance provider, ultimately led to $1.1 million in
state fines against Blue Cross’ parent company.
Health Care Service Corp. paid a March 2022 fine
of $339,000 for failing to notify the state in 2021 about the removal of
Springfield Clinic as an in-network provider. The Illinois Department of
Insurance fined HCSC $605,000 in March 2023 for violating the Illinois Network
Adequacy and Transparency Act. And a fine of $231,900 was issued on Nov. 3 for
failure to take all corrective action after the March fine.
In the latest fine, Blue Cross was cited for
sometimes listing incorrect travel times to providers in certain parts of the
state in online directories and not doing enough checking to make sure provider
networks were up to date.
Blue Cross said in its Dec. 22 statement that it
was “glad to have Springfield Clinic back in our network starting Jan. 1, as
part of an agreement that preserves access to quality health care for our
members and employer groups.”
The statement added: “The clinic has more than
650 well-respected medical professionals who once again are part of our network
of more than 130,000 providers across Illinois. This will continue our focus on
providing broad access to health care providers for our members and customers
across the state.”
People with questions about their coverage
should call the phone number on the back of their Blue Cross insurance card on
or after Jan. 1, the Blue Cross statement said.
Springfield Clinic said on its webpage that
people who have questions about insurance plans and in-network status should
contact the clinic’s Patient Advocate Center at 217-391-7086 after Dec. 26.
The new agreement pertains to most Blue Cross
plans except for Blue Choice, which is offered to state workers and people
receiving coverage through the Affordable Care Act’s online health insurance
exchange.
State Rep. Sue Scherer, D-Decatur, who saw her
insurance reform bill fail in the House in April 2022, said she reintroduced the
legislation as House Bill 4126 and plans to make another push for passage in 2024.
The 104-page bill would allow state officials to
confirm the existence of investigations of insurance companies. It also would
create more stringent standards for insurance providers to maintain accurate
online listings of doctors in their networks and more quickly adopt annual
federal recommendations on the number of specialty doctors needed for “network
adequacy.”
Scherer said many of her constituents called her
to say they had a hard time finding in-network doctors within a reasonable
distance and found flaws in Blue Cross’ online directories. Other constituents
paid out-of-network fees to keep their longtime Springfield Clinic doctors
before the contract dispute was resolved.
After learning the clinic will return to
in-network status with Blue Cross, Scherer said she was “doing my happy dance.”
She said her push for legislation “shed a light”
on the need for more regulations on health insurers to protect patients.
Scherer said she met separately with Blue Cross
and Springfield Clinic officials to push them toward a compromise. She issued a
news release taking some credit for the new contract.
The release said Scherer “helped to establish an
agreement that restores care to many Springfield Clinic patients.”
Scherer was quoted in the release as saying,
“Still, there’s more work to be done. And I will never stop fighting to hold
big health insurance companies accountable.”
Scherer’s bill, if passed, would “establish
stiffer penalties for health insurance companies’ inability to update provider
lists as quickly as possible,” the release said.
“Companies’ failure to do so has created ‘ghost
networks’ where a patient’s listed health care providers have moved away or are
now out-of-network,” the release said. “As a result, patients, especially in
central Illinois and rural communities, have to travel great distances to
receive essential care.”
Mike Murphy, president and chief executive
officer of the Greater Springfield Chamber of Commerce, called the new
agreement between the clinic and Blue Cross “a big win for the citizens of our
area.”
The Springfield area’s greatest potential for
economic growth in the next decade or two will be in the health care community,
he said. Resolving strife in that community is in everyone’s best interest, he
said.
“No one was a winner the past two years,” Murphy
said. “We don’t want any negatives. … I want to make sure all of our providers
are operating at 100%. I want them all to be clicking.”
Dean Olsen is a senior staff writer at Illinois Times. He can be reached
at dolsen@illinoistimes.com, 217-679-7810 or twitter.com/DeanOlsenIT.
