SPRINGFIELD, Ill. (NEXSTAR) — After weeks of sidestepping a months-long contract dispute between Blue Cross Blue Shield of Illinois and Springfield Clinic, Governor J.B. Pritzker on Wednesday publicly called on the two sides to return to negotiating table and reach a deal that would reconnect tens of thousands of patients with their favorite doctors.
“That’s precisely why we’ve imposed a fine; that’s precisely why we’ve said directly to BlueCross BlueShield that you need to be at the table negotiating with the Springfield Clinic,” Pritzker said at an unrelated press event in downtown Springfield.
Pritzker’s aides have met privately with representatives from Springfield Clinic and BlueCross BlueShield in recent days to urge them to overcome the impasse that has resulted in suffering for desperate patients.
BlueCross BlueShield has claimed Springfield Clinic is seeking a 75% raise in reimbursement levels for its physicians, but after several requests, the insurer has offered no evidence or documents to support that claim.
Springfield Clinic has also declined to show evidence of its rates, but says every other insurance provider in the region pays them the same or similar amounts for services.
While the two sides remain at impasse, patients are caught in the middle as hostages without adequate access to a full range of doctors and specialists who can treat them for their ailments.
“We want to make sure that there is network adequacy, and you can’t walk away from the table — either side I might add — but specifically Blue Cross Blue Cross Blue Shield,” Pritzker said. “They ought to be at the table working to resolve this.”
The company’s take-it-or-leave-it negotiation tactics have severed patients from affordable access to their doctors at Springfield Clinic, and in some cases have drastically diminished the benefit levels and medical coverage available to patients whose urgent conditions qualify for continuity of care.
The back of Jimmy Whaley’s BlueCross BlueShield insurance card says his plan would charge him no more than $2,500 if he sees an out-of-network doctor. However, after BlueCross adjudicated the claims for his cancer treatments, bills arrived at his doorstep totaling twenty-times more than that amount.
“The most we should be paying is $1,900, plus a $600 deductible,” his wife Sharon said. “It is not right.”
As a union electrician, the Whaley family gets their health insurance plan through a group insurance plan, which is regulated by the U.S. Department of Labor. They have appealed the BlueCross BlueShield documents in hopes they will still qualify for continuity of care at in-network rates for their radiation oncologist in Springfield Clinic.
After the mid-November split between the two parties, the Whaley family said there were no other radiation oncologists in the BlueCross network who could see him.
The Illinois Department of Insurance leveled a $339,000 fine against BlueCross BlueShield of Illinois’ parent company, Health Care Services Corporation, last week week after it claimed the insurer failed to follow the law and report a “material change” in its network of available providers.
Aurora mayor Richard Irvin, a Republican running for governor, called on Pritzker to fine BlueCross BlueShield every day it was out of compliance with the law. Once the first fines came down, Irvin’s campaign claimed credit for the idea, and criticized Pritzker for taking action at a “snail’s pace.”
“The snail’s pace in response to critical issues at Pritzker’s state agency speaks volumes about his priorities for Illinois,” said Irvin for Illinois Spokesperson Eleni Demertzis. “It’s clear the only thing that makes Pritzker step up are threats to his political future. Illinois needs a governor who will always step up regardless of politics.”
Five days after the fine was sent to BlueCross BlueShield of Illinois, a company spokesperson would not confirm whether the fine had been paid, or if it would appeal.
“We are evaluating the Department’s decision and next steps,” public relations consultant Kim Morreale McAuliffe said in an email. Her firm was brought on to help the insurance company navigate the PR fallout after a series of Target 3 reports outlined a number of ways patients with BlueCross BlueShield were struggling to find access to affordable health care.
Lobbyists for BlueCross BlueShield won temporary relief from public scrutiny on Tuesday when House Insurance Committee Chairman Rep. Thaddeus Jones (D-Calumet City) canceled a subject matter hearing. BlueCross BlueShield was invited to testify. Its public relations team did not answer whether or not any executives were prepared to show up and take questions, and did not provide any of the company’s written remarks prepared for that hearing.
Department of Insurance Director Dana Popish Severinghaus and several of her staff members were prepared to testify before the panel of lawmakers about the steps the agency has taken to regulate the insurance company, but never got the chance.
Doctor Kenneth Sagins, the Chief Medical Officer for Springfield Clinic, was also in attendance at the Capitol and waited outside the hearing room for several hours before it was ultimately canceled.
“What’s important to us is to come here and be the voice of the patient,” Dr. Sagins said. “Anything that will allow our patients to have access to high quality care, and be able to get the care that they deserve, we’re going to come here every day if we have to plant that message.”
The next day, Rep. Sue Scherer (D-Decatur), who called for the open hearing to apply pressure on the parties involved, filed a new bill to spell out specific fines and penalties for insurance companies that violate consumer protections in the law. The proposal would also allow the Department of Insurance to publicly disclose when an insurance plan is under a market conduct exam, and would allow several key details to be released to the public under the Freedom of Information Act.
“While we are still reviewing the legislation that was just filed today, we welcome the opportunity to improve clarity in how regulations are enforced and applied,” Morreale said.
Several lobbyists working for BlueCross BlueShield have approached legislators in recent days to discuss the matter.