A contract dispute means Springfield Clinic is no longer an in-network provider for families insured by Blue Cross and Blue Shield of Illinois.
The writer is divisional senior vice president, health care delivery, for Blue Cross and Blue Shield of Illinois.
For more than 80 years, Blue Cross and Blue Shield of Illinois has worked diligently to ensure that our members have robust access to support their health and wellness.
We contract and collaborate with over 100,000 providers here in Illinois to improve health outcomes, reduce costs and enhance the quality of care for our more than 8 million members – including nearly 10,000 Blue Cross and Blue Shield employees that live and work in Illinois, and thousands of employees right here in the central Illinois region.
We’ve been trying to work with Springfield Clinic for nearly a year to reach an agreement to continue to offer affordable and accessible health care to our members in the Springfield market. While we’ve kept diligently attempting to negotiate on behalf of our members, it was only just two weeks ago that we received Springfield Clinic’s very first specific counteroffer, even though we had been asking them for just that since June of 2021. Springfield Clinic, a for-profit entity, demanded a skyrocketing 75 percent increase in rates – even though their rates are already the highest in the Springfield market and tower 60 percent more than those in the Chicago market.
We’ve had Springfield Clinic providers in our network for more than 30 years and have a tremendous amount of respect for the staff and physicians who work there. In fact, we have consistently maintained a great relationship with them until they decided to send us a notice of termination for our Blue Choice relationship. Despite our best efforts, we have not been able to reach a deal that protects our members and employer groups from some of the highest health care costs in the state.
It is not in the best interest of our members and local employers in central Illinois to pass along the unfair burden of skyrocketing rate increases, who are already reeling from rising medical trends and inflationary expenses. Doubling the Springfield Clinic’s rates could cause local Springfield area small businesses to see an increase of up to 30 percent in their premiums. This directly hits their bottom line.
We understand how deeply personal health care is and, throughout the past many months, our top priority has been to care for our members, keeping them informed about the potential termination and then, their options for continued access to care amid the disruption. Members with questions about how Springfield Clinic’s network status affects their coverage is available at 1-877-325-2958 between 8 a.m. and 5 p.m. Monday through Friday. Our customer advocates are ready to help answer questions about specific benefits and provide guidance.
Members who are pregnant, being treated for a disability, acute condition or life-threatening illness, may be covered by what is known as “continuity of care.” This means they may still be able to use Springfield Clinic providers at the in-network benefit level under their current plan. In fact, since Springfield Clinic left our network in November, we’ve approved over 1,400 members’ requests for continuity of care – including members undergoing active cancer treatment. Their claims are among the 1 million we process every day. Our goal is to process these claims correctly 100% of the time. If we make a mistake, we want to fix it quickly.
Even though Springfield Clinic left our network, our local members can choose from more than 3,000 valued, in-network local providers who are aligned in our mission. We have and will continue to work closely with the State as we ensure access, affordability and quality in health care for Springfield residents.
While Blue Cross and Blue Shield of Illinois is fighting to curb health care costs against inflationary pressures, Springfield Clinic’s rates are already the highest in the Springfield area, and their unexplained demands simply fail to put patients and regional health care needs first.
We’ve come to the table, time after time, advocating for access, affordability and quality in health care for the millions of Illinoisans we serve. While it takes two to reach an agreement, for the past year it has really been us sitting at the table across from an empty chair.
We remain committed to working with Springfield Clinic to reach an agreement that is in the best interests of our members and employer groups.
Source by www.illinoistimes.com