SPRINGFIELD, Ill. (WCIA) — A year after the largest health insurer in the state kicked Springfield Clinic’s 650 providers out of network, the clinic is launching its own health plan.
Blue Cross Blue Shield of Illinois broke up a 30-year relationship between the go-to network of capital city specialists, and as Target 3 reporters revealed, that break up left at least 55,000 patients without their doctors or with staggering bills.
Plans to roll out Springfield Clinic’s first health plan after 80 years in business have been on the table “for a long time,” but the Blue Cross Blue Shield dispute increased the urgency to roll it out, clinic vice president of brand, experience and advocacy Zach Kerker said.
“The number of calls that we’ve received from patients and employers over the past year just helped us realize that this is something that we need to do now,” he added.
The clinic launched the Springfield Clinic Advantage plan and associated website Tuesday in partnership with Decatur-based Consociate Health.
“I think that ideally, we would have an agreement with Blue Cross Blue Shield. We want to have agreements with all the insurers that have patients in our area,” Kerker said.
“That being said, we’ve sent multiple proposals in the past several months, with varying degrees of compromises, all of which have been declined with no counterproposal.”
Blue Cross Blue Shield spokespersons declined to answer whether the company has provided any counterproposals or compromised on financial terms during the more than a year-long negotiation process.
The email response reiterated the insurer’s months-long stance that it has “proposed an arrangement to the Clinic that would deliver quality and value for our customers and members but, to date, the Clinic hasn’t shown interest in such an arrangement.”
“So I think the reality right now is that we’re out of network with Blue Cross Blue Shield,” Kerker said. “And I think that that’s our reality for the foreseeable future.”
The plan rollout was about more than potentially patching the healthcare gap left by apparently stalled negotiations between the two companies, Kerker said.
“This isn’t just about one insurer, this is about a patient’s ability to have that access to their Springfield Clinic provider, no matter what the situation is,” he added.
“The disparity between the healthcare organizations who are trying to provide the care and the insurance companies that are growing, I really feel like our dispute that we’re in right now is just the tip of the spear of what people are going to experience over the long haul.”
Springfield Clinic isn’t the only large local health network to launch a plan. Carle Foundation Hospital in Urbana created its own in partnership with Health Alliance, and since then, it and Carle Physician Group (a network of more than 550 Carle doctors) cut ties with any other Medicare Advantage plans.
When asked, Kerker said Springfield Clinic has no plans to stop contracting with any other health insurance companies as a result.
“No. I mean, our goal is to be in network with all of those insurers. That’s what’s best for us, that’s what’s best for patients,” he responded.
Springfield Clinic Advantage is available to employers with 10 or more workers. Any doctors and facilities currently in-network with Health Link are in the Springfield Clinic network, including all Springfield and most other central Illinois hospitals, Kerker said.
“Almost all hospitals in the state of Illinois are, and the Health Link network is more than a million providers nationwide.”
The Illinois Department of Insurance in March levied a $339,000 fine against Blue Cross Blue Shield for failing to report to the department a “material change” caused by the break up with Springfield Clinic.
The Network Adequacy and Transparency Act of 2017 requires insurers to maintain a “minimum ratio of providers,” and to report a “material change” to the Illinois Department of Insurance if it significantly reduces the number of providers in its network.
The first-ever fine of its kind was announced two weeks after Target 3 first exposed dead ends in the insurer’s doctor network.
Within weeks, the Department of Insurance forced Blue Cross Blue Shield to refile its network for review.
Depending on those results, additional penalties against the insurance company could be in store.
Following a request for an update on its investigation this week, a spokesperson for the Department of Insurance responded with a statement identical to one they provided early this month.
“The network adequacy filing for HCSC/Blue Cross Blue Shield of Illinois remains under review, and the Department does not comment on filings that are under review. When the Department’s review is complete, we will provide an update,” the email read.
CORRECTION: This article has been updated to clarify that it is Carle Foundation Hospital and Carle Physician Group that only contract with the partnered Health Alliance Medicare Advantage plan. There are other doctors and facilities in the Carle Health system that accept a broader range of Medicare Advantage plans.