In a legislative hearing on Wednesday evening, lawmakers met with representatives of Blue Cross Blue Shield of Illinois, Springfield Clinic and the state Department of Insurance.
The hearing was to investigate the relationship between Blue Cross Blue Shield and Springfield Clinic. After the two organizations failed to reach a contract agreement last year, the insurer cut Springfield Clinic from its network in November.
The removal of Springfield Clinic resulted in at least 55,000 Blue Cross customers needing to find new doctors or file continuity of care requests with Blue Cross, according to Krishna Ramachandran, a senior vice president with Blue Cross Blue Shield of Illinois.
Springfield Clinic estimates the number of affected patients is closer to 110,000, according to Ken Sagins, the clinic’s chief medical officer.
Lawmakers from both parties on Wednesday said that the situation has resulted in constituents calling them, asking for help or sharing stories of frustration in trying to deal with the situation.
"This is a cancer that’s growing that we’ve got to find solutions to," said Rep. Sue Scherer, D-Decatur.
Scherer does not sit on the State Government Administration Committee, which held Wednesday’s hearing. She joined the committee in questioning because of her personal advocacy for the issue and her championing of HB 5279, a bill which would introduce statutory guidance on enforcing the Network Adequacy and Transparency Act, a state law from 2017.
Blue Cross Blue Shield was fined $339,000 for violating this law last week.
Scherer opened the meeting in an emotional moment in which she said there had been an emergency threatening the life of her son-in-law earlier on Wednesday. Scherer said that she was worried because her son-in-law has Blue Cross Blue Shield insurance.
"It’s very personal to me right now," said Scherer. "It wasn’t when I went to bed last night, but it is today. I need answers."
One of the central themes of Wednesday’s hearing was the negotiations between Blue Cross and Springfield Clinic. The insurer alleges that talks broke down when Springfield Clinic asked for a 75% increase in reimbursement rates, leading to the negotiation breakdown.
Sagins on Wednesday indicated this framing was misleading. In his view, the issue actually centered on how Blue Cross Blue Shield was transitioning thousands of patients to "Blue Choice" plans, an Affordable Care Act plan originally intended for a limited audience. When Springfield Clinic said having a significant increase in the number of Blue Choice patients wasn’t possible, that’s when talks started to break down, according to Sagins.
"It was never intended to be pushed out to the general population," said Sagins.
Wednesday’s hearing also focused on discussing so-called "ghost networks," which is a term to describe insurance companies listing doctors and other medical providers that aren’t accepting patients or that don’t exist in order to comply with state and federal laws.
Cheryl Brown, an OB-GYN at Springfield Clinic and former chair of the obstetrics and gynecology department, also testified to the committee. Brown said that, in trying to help her patients find new doctors, she checked Blue Cross Blue Shield’s list of providers in the Springfield area and found something that troubled her.
"These names are not real," she said. "They do not exist, but they are on the list."
She also said she found names of doctors listed as obstetrician-gynecologists who no longer work in the field or who don’t practice in the specialization.
This inability for patients to find doctors close to them or doctors who have time to see them can be life-threatening.
"I have a patient. She is hemorrhaging," said Brown. "She needs a hysterectomy. It is not feasible for her to wait 3 months, 6 months, 9 months."
Outside of gynecology, Sagins said he was aware of at least two radiation oncologists listed as providers on Blue Cross’ list that were Springfield Clinic doctors and one from Chicago.
"There has to be some sort of consequence," said Rep. Sandy Hamilton, R-Springfield.
Blue Cross Blue Shield is the largest private insurer in Illinois, with 8.1 million members in the state, according to its website. Springfield Clinic’s doctors serve more than 90 locations in 20 counties around central Illinois, with locations in Springfield, Jacksonville, Alton, Lincoln and more, according to Sagins.
Scherer’s bill is set to be heard in the House State Government Administration Committee in the next few days, according to the committee’s chair, Rep. Stephanie Kifowit, D-Oswego. She added that the hearing, originally scheduled to be in the House’s Insurance Committee, was placed in her committee because Scherer’s bill is focused on changing regulations surrounding the Illinois Department of Insurance, a state administrative body.
via The State Journal-Register
March 31, 2022 at 07:49PM