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* Mark Maxwell…
The contract dispute that disrupted continuity of care and sent medical bills skyrocketing for Springfield Clinic patients with Blue Cross Blue Shield insurance plans impacted several state and federal lawmakers living in Central Illinois.
“I know I speak on behalf of my constituents, but you know I have health insurance, too,” state senator Doris Turner (D-Springfield) said on Wednesday. “I have family members that have health insurance coverage, so it becomes very personal.”
In a recent radio interview, Turner described how the disruption in coverage and benefits nearly complicated the pregnancy of a member of her family. When Blue Cross Blue Shield kicked Springfield Clinic’s 650 doctors out of its network, patients who relied on that insurance plan suddenly learned they’d have to pay much higher out-of-network prices to continue seeing their favorite doctor or specialist.
“It created a lot of anxiety,” Turner said. “When people have insurance, they just assume that that health care is going to be accessible to them whenever they need it.”
Blue Cross Blue Shield, the largest health insurer in the state, said it “cannot and will not arbitrarily overpay” Springfield Clinic under the terms of their old contract. The two sides have not shared specific details underlying the contract dispute, but a spokeswoman for Blue Cross said medical costs in Springfield are “among the highest in the state – as much as 16% higher than Chicago.”
In its push to drive costs lower, Blue Cross is driving Springfield Clinic patients to other doctors, and in many cases, it is driving its own paying customers to cancel their insurance plans.
Congressman Rodney Davis (R-Illinois 13th District) and state senator Steve McClure (R-Springfield) were among the patients to cancel their insurance coverage with Blue Cross over the dispute.
“I left BCBS after being a customer for 25 years because of this dispute and our loyalty to the great doctors and care we get from Springfield Clinic,” Davis said through a spokesman. “In fact, my wife received her own cancer treatments from the health care community in Springfield under BCBS coverage 23 years ago.” […]
McClure called it “very troubling” that “people that need health care — that have what is supposed to be a fantastic plan — can’t get reasonable coverage for things that they need, and trying to go to a provider, that is nowhere near them, that maybe doesn’t exist before they get coverage.”
“If that were my mom and dad, they wouldn’t have a way to go to a specialist in Chicago or or St. Louis,” state senator Sally Turner (R-Lincoln) said. “They wouldn’t be able to get there unless I personally could take them there.”
* Big Blue is definitely feeling the heat. From an internal company memo…
Steve Hamman
Illinois Plan PresidentTo: BCBSIL Employees
Springfield Clinic Reporting
Likely, you have heard about and/or been directly impacted by Springfield Clinic leaving some of our networks last November, so I wanted to connect with you, as Central Illinois employees — and as Blue Cross and Blue Shield of Illinois members.
We understand how deeply personal health care is and, as you well know, we don’t often “break up” with providers. Unfortunately, Springfield Clinic, a for-profit entity, is demanding a 75% increase in their reimbursement rates on top of their current inflated reimbursement already 60% higher than Chicago. That unfair burden would fall on all members and employer groups in Central Illinois, already reeling from inflationary expenses during these challenging times.
What matters most is how we support our members — including you. Our purpose is to do everything in our power to stand with our members in sickness and health, and we strive to live up to that every day. Delivering exceptional customer service is top of mind for all of us, but recent media reports aren’t sharing the full picture about how we’re treating some of our members previously or currently served by Springfield Clinic.
More than 1,400 of our members have been approved for continuity of care, allowing them to continue treatment for serious health conditions at Springfield Clinic and at the in-network benefit level. When we learned some members’ claims may not have been processing correctly, we began reviewing all of them to make sure they’re right. We’re not perfect, but when we find errors, we fix them.
It’s been unfortunate that we’ve not been given opportunities to respond to these media reports in their full context and were denied member information in advance of the news stories to research and respond, which has created misleading representations of our company and our work on behalf of our members in Central Illinois.
One report questioned the validity of our Central Illinois networks, even though we offer more than 3,000 care options for members no longer served by Springfield Clinic — and that number is growing. Several hundred members each month are finding and using other in-network providers in Central Illinois including Memorial Health, SIU, and St. John’s to meet their health care needs –- numbers we see in our claims data.
We all work hard to live up to our purpose. I want you to understand the truth about how we’re being portrayed and to be proud of our commitment to members and the communities we serve. We will continue to strive for value in health care –- affordability, access and quality — for you, our members and our employer groups. Thank you for representing BCBSIL so well in all you do!
posted by Rich Miller
Monday, Mar 14, 22 @ 10:56 am
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reads to me that the Springfield Clinic could be in the wrong here.
Comment by Blue Dog Monday, Mar 14, 22 @ 11:07 am
I didn’t have the option to change insurance so I’m changing all of my doctors. It’s a huge pain, but I’ll never go back to Springfield Clinic.
Comment by DCC Monday, Mar 14, 22 @ 11:12 am
The Blues and the Clinic both look bad here. Big battle between an important healthcare provider and an insurance company. Huge issue in Springfield. Deserved damage is being done to both. Feels like some personalities might be involved. Needs to get fixed.
Comment by Lew Monday, Mar 14, 22 @ 11:14 am
===reads to me that the Springfield Clinic could be in the wrong here===
They are. They’ve overplayed their hand and it’s going to hurt everyone involved.
Comment by AD Monday, Mar 14, 22 @ 11:15 am
Some are waiting for Peoria media to catch up on this. Why one might ask? ‘Cause SC is doing a lot of marketing there.
Comment by Annonin' Monday, Mar 14, 22 @ 11:16 am
Springfield Clinic needs to realize the BCBS doesn’t need them. BCBS has 8.1 million members in Illinois, this is a blip on their financial radar, and for most services, there are other providers in town (SIU, HSHS, Memorial).
This is much more than a blip on Springfield Clinic’s radar. More like the iceberg that sank the Titanic.
Comment by AD Monday, Mar 14, 22 @ 11:21 am
I guess AD is with the Blues. That’s the type of macho bluster that keeps unnecessary conflicts like this going. Again, this is bad for both sides and bad for Springfield residents. Wondering if the Mayor’s office has tried to help.
Comment by Lew Monday, Mar 14, 22 @ 11:28 am
==Some are waiting for Peoria media to catch up on this. Why one might ask? ‘Cause SC is doing a lot of marketing there.==
Plus Quincy–since Springfield Clinic has offices in Macomb (and Macomb is in the Quincy TV market).
Comment by NonAFSCMEStateEmployeeFromChatham Monday, Mar 14, 22 @ 11:34 am
BCBS average rate increase for Illinois employers was 18% this year. These are filed rate increases and are because of the healthcare monopolies and prescription drug cost increases in this state and around the country.
Comment by Chicagonk Monday, Mar 14, 22 @ 11:47 am
Lew - No, I’m not with or affiliated with the Blues in any way. I don’t have a dog in the fight as I go to Memorial and have a different insurance provider.
And I am not going for macho bluster, just a realist that realizes the size comparison between the two and how that affects negotiations. Springfield Clinic patients make up about 1% of BCBS patients. I’m going to guess the BCBS makes up a much larger portion of Springfield Clinics’ client base.
Comment by AD Monday, Mar 14, 22 @ 11:48 am
Remember, it is BCBS telling you SC charges too much. What does “higher than Chicago” really mean? That’s just nonsense unless BCBS provides real numbers.
“Executives at Springfield Clinic say the dispute began when Blue Cross started steering a higher volume of patients onto a much cheaper insurance plan that was initially set up to provide barebones coverage for the previously uninsured. . . . The Blue Choice plan covered roughly 10,000 patients at Springfield Clinic, according to Kerker. When Blue Cross started selling that cheaper, lower-paying plan to a broader pool of patients, the clinic stopped accepting it.”(
Comment by Sangamo Girl Monday, Mar 14, 22 @ 11:49 am
Very reminiscent of the Quinn vs. Health Alliance and Humana fight almost 11 years ago (when the Governor’s office tried to push HA and Humana, among others, off the state employee health insurance options in favor of BCBS). So glad that was resolved as I was very close to switching to BCBS too, I was working on the paperwork when the compromise was announced (I have HA and with Springfield Clinic).
Comment by NonAFSCMEStateEmployeeFromChatham Monday, Mar 14, 22 @ 11:49 am
Most of my specialists are at Springfield Clinic. It is still taking 3-4 months to get an appointment. I don’t think it’s hurt them too much, at least not yet.
Some family members that BCBS forced to find new doctors are waiting more than 6 months though.
Comment by Nilwood Monday, Mar 14, 22 @ 11:54 am
The bigger issue is those with HMOs through BCBSIL get their primary care coverage routed through medical groups. Those medical groups are not transparent in the least as to who is covered, how coverage is determined, or to what extent. They may cover specialists, but the specialists will only have privileges at certain hospitals which the medical group does not have in-network status at.
Comment by Unionman Monday, Mar 14, 22 @ 11:57 am
===reads to me that the Springfield Clinic could be in the wrong here.===
This is a complicated issue. If I were a law maker I would be very hesitant to weigh in without a very in depth understanding of what is going on which is why I would call for a hearing and not weigh in until I and or my staff had the opportunity to review Springfield Clinic’s chargemaster and other basic accounting information.
This is another fine reason why we need to just have universal single payer as a federal policy.
Comment by Candy Dogood Monday, Mar 14, 22 @ 12:02 pm
===and trying to go to a provider, that is nowhere near them, that maybe doesn’t exist before they get coverage.”===
This is not related directly to the dispute, but it seems like this specific state representative is suggesting he is completely unaware of the issues with under service of rural areas throughout Illinois? Just an odd thing to be saying if you’re an elected official. Not as odd as publicly endorsing a massive healthcare providing corporation without naming any specific physician or nurse who was actually responsible for the medical care you received.
I don’t want to get too accusatory, but that sounds like a prepared statement from a commercial, but maybe it is.
Comment by Candy Dogood Monday, Mar 14, 22 @ 12:07 pm
“Unfortunately, Springfield Clinic, a for-profit entity…” A for-profit entity trying to make a profit is trying to throw shade over a for-profit entity trying to make a profit. Where does the patient’s health come into play?
Comment by Skeptic Monday, Mar 14, 22 @ 12:20 pm
=== throw shade over a for-profit entity trying to make a profit===
The Blues are not-for-profit. Yeah, I know, but still.
Comment by Rich Miller Monday, Mar 14, 22 @ 12:21 pm
So happy we finally made it to Medicare. Why anyone believes universal health coverage would be bad is a mystery to me. And yeah, the Blues are not-for-profit, but that building in Chicago is durn purdy.
Comment by Stix Hix Monday, Mar 14, 22 @ 1:11 pm
While it will only be a blip for BCBS, but local employers need to provide their employees with an alternative that will cover Springfield Clinic. Unfortunately many local employers also rely on the same insurance broker that I’m sure has zero interest in avoiding doing business with BCBS.
Comment by Concerned Dem Monday, Mar 14, 22 @ 1:38 pm
== And yeah, the Blues are not-for-profit, but that building in Chicago is durn purdy.==
Trust me, the Clinic’s offices are nothing to sneeze at. The biggest complicating factor for many in the Springfield area is that there are few other options. Memorial Physician Services has a couple of offices in Springfield, but pretty much every other health care location in the area is owned by the Clinic. For-profit means that the Clinic can pay top-dollar for staff (even though they don’t, because “for-profit”), but they also charge more than anywhere else. Hopefully this fight will help break the stranglehold the Clinic has in that area and will lead to more healthcare options for everyone.
Comment by Lester Holt’s Mustache Monday, Mar 14, 22 @ 1:55 pm
After the annoying few months my spouse and I have had with my insurance provider ( not Blue), I’ve definitely ready for universal health care. It won’t happen before i am eligible for Medicare. I’ve also already decided that I’m signing up for a Supplement not Advantage. I’m tired of private insurers making my life miserable. They do their best to get out of paying for legitimate medical expenses due to an injury, or to delay approval for legitimate surgery for a proven condition.
Comment by thoughts matter Monday, Mar 14, 22 @ 2:10 pm
I’m keeping my Springfield Clinic diabetes doctor, although instead of it costing me $40, it is costing me $365 every time I go. On the reverse side, I can’t afford to see my Springfield Clinic eye doctors any more. Such a shame for everyone!
Comment by Sal Monday, Mar 14, 22 @ 2:20 pm
Why hasn’t the Illinois department insurance intervened?
Comment by Anonymous Monday, Mar 14, 22 @ 2:26 pm
It’s interesting how all of these organizations crow about “caring for the community”, then pull something like this. Memorial employees knew about this almost a year ago, so I’m sure our illustrious senators and reps did as well. The corner office dwellers needed to put their big boy pants on and sit down at the table last year.
Comment by Knee deep in nonsense Monday, Mar 14, 22 @ 2:58 pm
My primary dr retired from Springfield Clinic at the end of 2021. He didnt like the direction he was being given for treating his patients. Specifically the senior citizens & chronically ill patients.
Comment by Peanut Monday, Mar 14, 22 @ 3:31 pm
“It’s been unfortunate that we’ve not been given opportunities to respond to these media reports in their full context and were denied member information in advance of the news stories to research and respond, which has created misleading representations of our company and our work on behalf of our members in Central Illinois.”
Gotta admit I appreciate that Mark Maxwell noting that he offered BCBS a chance to sit for an interview as far back as March 2nd; BCBS declined. (Everyone is shocked, shocked, I’m sure.)
Not to mention that, if this *was* a thoughtfully-made business decision (with, presumably, a mountain of associated due diligence) for BCBS, there shouldn’t need to be a lot of “research” to explain why BCBS thinks they are in the right on this.
Not that I trust the Clinic’s word either on this. Just sayin’.
Comment by Chambananon Monday, Mar 14, 22 @ 3:34 pm
Anon 2:26, maybe because it is a contract dispute not a regulatory manner. Not a DOI issue.
Comment by Original Rambler Monday, Mar 14, 22 @ 4:16 pm
OR,
We will be in agreement not to be in agreement. So are the local laissez-faire officials and even the state medical society. Perhaps the medical society would have a different opinion if the department of professional regulations were involved.
Comment by Anon 2:26 Monday, Mar 14, 22 @ 5:29 pm
I’m thinking in the end that BCBS will comply but Springfield Clinic will have to restructure to make itself more cost effective.
Comment by The Dude Tuesday, Mar 15, 22 @ 3:23 am