SPRINGFIELD, Ill. (NEXSTAR) — House Democrat Sue Scherer said she is tired of getting calls from people in her district about Blue Cross Blue Shield of Illinois.
Now, she wants the state to take unprecedented action against the largest health insurance provider in the state.
“It’s called a cease-and-desist order,” Scherer (D-Decatur) said.
Scherer and representatives from Springfield Clinic count 92 of the clinic’s doctors that remain on the Blue Cross Blue Shield directory, despite the clinic and the health insurance company splitting more than a year and a half ago.
Scherer wants the Department of Insurance to stop Blue Cross Blue Shield from taking on any new clients until they fix the issue.
“You can’t operate a business and say you’re offering a product that you don’t really offer,” Scherer said. “And until they get their list, I don’t want this to happen to Blue Cross.”
Blue Cross Blue Shield of Illinois acknowledged that those providers are in the directory, but the company disputed the claim that there are problems with its directories. The company said it’s because they are affiliated with a different facility, or with other health insurance plans like government-sponsored plans.
“If a provider is also affiliated with another facility or medical group, the provider will be listed as in-network with that facility or medical group,” a spokesperson for Blue Cross Blue Shield said in a statement. “This information, including the locations and addresses where a provider offers in-network services for a particular plan, is displayed on the provider directory.”
The Department of Insurance responded to a series of questions Monday night. A spokesperson confirmed the department has the power to issue a cease-and-desist order, but did not give any indication that they were even considering the measure.
“Provider directories are legally required to include the full roster of providers that have any contractual relationship with the insurance company, including providers with admitting privileges and/or a secondary contractual relationship,” a spokesperson for the Illinois Department of Insurance said in a statement.
The Department of Insurance has already completed an investigation into Blue Cross Blue Shield.
So far the company has racked up around $1 million in fines from the state.
One of the reasons that the state fined the company over $600,000 in March of 2023 was because Blue Cross Blue Shield “failed to make its provider directories clear for consumers to determine which directory applies to which plans.”
Springfield Clinic representatives took issue with the state’s interpretation of the law, since it allows the company to include doctors who are only part of the network under certain circumstances.
“This interpretation would create a loophole for insurers that effectively renders the Network Adequacy Act useless against ghost networks,” Zach Kerker, Chief Brand and Advocacy Officer for Springfield Clinic, said in a statement. “Patients cannot establish relationships with any of the 92 physicians listed as ‘in network’ on Blue Cross’ directories. This act is a consumer protection law and should protect patients, not big insurance.”
Scherer is not the only lawmaker to urge the Department of Insurance to crack down on the Blue Cross Blue Shield. Three other Central Illinois lawmakers have written letters to the Department of Insurance calling for it, including Senator Doris Turner (D-Springfield), Senator Steve McClure (R-Springfield) and Representative Mike Coffey (R-Springfield).
Coffey has been in office for less than a year, but he has now seen the impact of the split between Blue Cross Blue Shield and Springfield Clinic from three different perspectives. He and his family are Blue Cross Blue Shield customers who paid out of pocket to remain with a Springfield Clinic doctor, and he is a small business owner who uses Blue Cross Blue Shield for his employee health insurance plan.
He would not go so far as to endorse Scherer’s call for the department to issue a cease-and-desist order.
“I think we need to start by finding out if the accusations are true or not,” Coffey said. “And then we need to get them in the room and do it Blue Crew. We don’t want Blue Cross to leave the State of Illinois. It’s a good insurance company. And we love Springfield Clinic. So I want them to get together and solve the issue. That’s what I want.”
Scherer wants to see the department get more aggressive with how it polices health insurance companies. She felt the department is not going far enough in how it analyzes the directories of major health insurance companies.
“I would like to see them to be a little more assertive, and to be checking if these businesses are operating the way they say they are, instead of requiring our constituents to keep filing complaints about this,” Scherer said.