Agreement reached between Blue Cross Blue Shield and Springfield Clinic: What to know
Blue Cross Blue Shield of Illinois and Springfield Clinic have reached an agreement, ending a years-long rift between the health insurance provider and medical group.
For the past two years, the insurer and healthcare group could not find common ground. At least 55,000 Blue Cross customers had to find new healthcare providers as a result.
Related: A year after split with Blue Cross, Springfield Clinic offers patients new health plan
The agreement allows Blue Cross insurance holders to receive in-network care at Springfield Clinic.
"Springfield Clinic and Blue Cross and Blue Shield of Illinois have agreed to a new five-year agreement that will allow patients/members to return to in-network status at Springfield Clinic beginning on Jan 1, 2024," Justin Fowler, a spokesperson for Springfield Clinic, said in a statement.
According to a BCBS statement the new agreement "preserves access to quality health care for our members and employer groups.
"The Clinic has more than 650 well-respected medical professionals who once again are part of our network of more than 130,000 providers across Illinois. This will continue our focus on providing broad access to health care providers for our members and customers across the state."
Over the two-year dispute, the state fined Blue Cross several times because of outdated information in its provider directory. The insurer's parent company, Health Care Service Corporation, received a $231,900 fine from the Illinois Department of Insurance last month.
Blue Cross has since updated its directory and has complied with other state orders.
State Rep. Sue Scherer, D-Decatur, has been pushing health insurance reform in the Illinois General Assembly to address "ghost networks," where insurance companies list health care providers that are either not accepting new patients or who are otherwise unavailable.
Her legislation would establish a $5,000 monthly penalty for insurers with provider lists that are not up-to-date. IDOI would also hold broader emergency rule-making ability to establish federal-level standards for travel time and distance, provider ratios, and appointment wait times if they exceed those of the state.
An attempt last year failed, not receiving enough votes in the House. It was reintroduced this year under House Bill 4126, which never advanced out of committee.
Scherer said Friday she will continue her push following the agreement between Blue Shield and Springfield Clinic. The deal was "quite a victory" for her constituents, she said.
"My bill was not just that narrow to Springfield Clinic and Blue Cross," she said. "I'm going to keep pushing my bill to make sure that this doesn't happen with some other group."
Springfield Clinic rolled out its own health plan during the dispute called “Springfield Clinic Advantage,” available to employers with 10 or more employees in central Illinois. Fowler confirmed the plan will remain available once the agreement with BCBS goes into effect.
Patients wanting to set up in-network care can call Springfield Clinic after Dec. 26.
Contact Patrick M. Keck: 312-549-9340, pkeck@gannett.com, twitter.com/@pkeckreporter.
This article originally appeared on State Journal-Register: Blue Cross Blue Shield, Springfield Clinic reach agreement
