"Illinois doctors urge patients to file complaints with the Illinois Department of Insurance whenever they experience these 'ghost network' issues," he said. Regan Thomas said the state insurance department should "enhance its enforcement" of a 2017 state law requiring insurers to keep their published physician networks up to date. Illinois State Medical Society president Dr. She said the insurer continues to increase the number of primary and specialty care providers in its network and "welcomes the opportunity to help members who are having a hard time finding an available provider."Ī recent WCIA-TV broadcast on the dispute said Blue Cross' online directory of Illinois providers contains inaccuracies that could be frustrating to patients trying to find new doctors. Kerker said in an email on March 11 that clinic officials "applaud the Department of Insurance efforts to protect access to excellent health care for patients in central Illinois."īlue Cross spokeswoman Colleen Miller said in an email that "many members are finding and using care provided by the approximately 3,000 providers in our network in central Illinois." "The reality is there aren't enough in-network options in this area, and BCBSIL's decision to terminate Springfield Clinic from the PPO plan has forced countless people to forgo or delay care," clinic spokesman Zach Kerker said in February.
It's unclear when or whether a resolution to the conflict will be reached, and insurance analysts in the area have said some Blue Cross members have postponed leaving the clinic and establishing relationships with other groups such as Southern Illinois University School of Medicine, HSHS Medical Group and Memorial Health. The situation has forced patients and their employers to decide whether to switch insurance carriers – if that's an option – or seek care from medical groups outside the for-profit clinic, which is based in Springfield and provides care at 90 locations in more than 20 downstate counties.Įmployees and their family members still covered by Blue Cross have had to decide whether to pay higher out-of-pocket costs for sticking with clinic doctors now classified as out-of-network providers.īlue Cross members being treated for a disability, acute condition, life-threatening illness or in the third trimester of pregnancy have been able to ask Blue Cross for "continuity of care" approval to pay in-network charges when seeing their clinic providers.īoth Blue Cross and Springfield Clinic say they have negotiated in good faith but haven't been able to work out a deal that would put the clinic back in the Blue Cross network. Blue Cross says 55,000 patients are affected. Springfield Clinic officials have said the dispute has affected about 100,000 Blue Cross-insured patients. "If an insurer fails to provide an adequate network and the consumer makes a good-faith effort to access in-network care, the insurer must allow a consumer to access an out-of-network provider at an in-network rate," she said.īlue Cross, the largest health insurance company in the state, removed Springfield Clinic from its preferred-provider network in November as part of a contract renewal dispute over reimbursement rates. "The network-adequacy filing is under review, and the department does not comment on filings that are under review," Brookens said in an emailed response to questions from Illinois Times. All of the potential ramifications of an unfavorable ruling for Blue Cross also are unclear. It's unclear when the department will make a decision. 18 it must submit a "network-adequacy filing," department spokeswoman Caron Brookens said. The Chicago-based insurer sent documents to the Illinois Department of Insurance after the department told Blue Cross and Blue Shield on Feb. State officials have asked Blue Cross and Blue Shield of Illinois to prove that its central Illinois health care network remains adequate for meeting patients' needs, despite the loss of more than 600 Springfield Clinic doctors and other providers from its network. Regan Thomas said the Illinois Department of Insurance should “enhance its enforcement” of a state law requiring insurers to keep their published physician networks up to date.
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