image

health as it happens

With Blue Cross coverage change a month away, Springfield Clinic warns 100,000 patients - The State Journal-Register

play

Springfield Clinic criticized the “record profits” earned by Blue Cross and Blue Shield of Illinois’ parent company during the COVID-19 pandemic in letters and emails this week to about 100,000 Blue Cross-covered patients who could lose access to their clinic doctors Nov. 17 and beyond.

“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 says.

“Their decision will have a simple and direct impact on you — it will increase your out-of-pocket costs to see your Springfield Clinic provider beginning Nov. 17, 2021,” the letter says.

Springfield Clinic, a for-profit business with more than 600 doctors and advanced-practice practitioners in 80 different medical specialties, has been in a contract dispute for months with Blue Cross, the state’s largest insurance company, over reimbursement rates. 

Previously: Dispute between Springfield Clinic, Blue Cross could disrupt care for 100,000 patients

The lack of a resolution by Nov. 17 would result in higher out-of-pocket payments for patients covered by preferred-provider Blue Cross plans who use Springfield Clinic. The clinic, currently an "in-network" provider for Blue Cross, would become an "out-of-network" provider. 

Springfield Clinic officials declined to speak with The State Journal-Register about the most-recent letter. But they have said on the clinic’s website that they “do not anticipate a resolution” with Blue Cross and Blue Shield.

Clinic officials indicated on the website that contract terms backed by Blue Cross would hurt the clinic financially and make it harder for the clinic to attract and retain doctors, especially specialists, in central Illinois and “restrict our ability to acquire the latest innovative treatments and technologies.”

The clinic letter quotes a 2020 story in Crain's Chicago Business that says Blue Cross' parent company, Chicago-based Health Care Service Corp., saw a 14.5% increase in net income in the first half of 2020 compared with the first half of 2019.

Springfield healthcare: St. Joseph's Home of Springfield, a Catholic nursing facility, is closing in December

Health Care Service Corp., which also operates Blue Cross plans in Texas, Montana, New Mexico and Oklahoma, saw its profits increase from $2.27 billion in 2019 to $3.98 billion in 2020, an increase of 75%, as the pandemic took hold. This increase in profitability was a nationwide trend as patients delayed care and health insurance companies benefited financially by paying out fewer claims.

Krishna Ramachandran, Blue Cross’ divisional senior vice president for health care delivery, wouldn't divulge details of contract talks but told the SJ-R he remains optimistic the dispute can be resolved.

“Obviously, it takes two to tango,” he said Friday. “We’ve been in regular communication with them. ... Obviously, we value Springfield Clinic and the care that their doctors and providers give our members. We really hope they stay in our network.”

Uncertainty about the situation is causing anxiety and frustration for local employers and their employees, according to Andrew Novaria, a health insurance broker at American Central Insurance Services in Springfield.

Most employers he works with plan to stick with their Blue Cross coverage even though many employees might have to leave their longtime doctors to avoid higher out-of-pocket medical expenses. Some employers are looking for other health plan options so employees can retain their clinic providers, he said.

Trending now: Chicago mayor says police won't be sent home over their COVID-19 vaccine status — yet

“Blue Cross is significantly less expensive than some of the other options out there,” Novaria said. “People don’t want to pay any more for health insurance than they are paying today.”

Springfield Clinic officials say in their letter that patients are encouraged to consider “self-pay” options and contact the clinic’s patient advocacy center at (217) 391-7086 for assistance.

Officials said patients can continue to see their doctors using out-of-network benefits and contact their employers’ benefit-plan administrator to determine whether they can switch plans and still see clinic providers on an in-network basis.

Clinic officials also said patients can call Blue Cross to determine whether their ongoing treatment, for conditions such as pregnancy and cancer, qualifies for “continuity of care” coverage at the same rates after Nov. 17.

As of Aug. 19, services at Springfield Clinic’s outpatient Ambulatory Surgery and Endoscopy Center in Springfield became out-of-network for Blue Cross PPO members.

Plans not impacted and remaining in-network with the clinic included BCBSIL Community Health Plan (Medicaid); BCBSIL Medicare-Medicaid Alignment Initiative (MMAI), BCBSIL HMO UnityPoint (Site 457) for Peoria only, and BCBS Medicare Supplements.

This story will be updated.

Contact Dean Olsen: [email protected]; (217) 836-1068; twitter.com/DeanOlsenSJR.