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November 2015
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  • BCBSIL Drops Popular Product for 2016 ACA Marketplace - Effective Jan. 1, 2016

    Thousands of Illinois patients who purchased health care coverage through the ACA Marketplace may be in for a surprise next year: Blue Cross and Blue Shield of Illinois (BCBSIL) recently announced it will discontinue its "Blue PPO" product, effective Jan. 1, 2016.  

    Unless the approximately 173,000 Illinois patients who currently have this coverage choose a different health plan during the Marketplace open enrollment period, they will be automatically transitioned to BCBSIL's "Blue Choice Preferred PPO."

    However, with only half of the hospitals in the state included, the Blue Choice Preferred PPO network is significantly more limited than the Blue PPO network. This change will reduce in-network options for your patients.

    All of your patients who purchase insurance coverage via the ACA Marketplace have an opportunity to "shop around" during the open enrollment period, which ends December 15 for current insureds. Many plans have imposed significant premium increases, which may prompt your patients to look at other options.

    If you have patients who are currently enrolled in a Blue PPO plan, now is the time to work with them to minimize disruptions in care for 2016.

    ISMS has obtained important guidance from BCBSIL to help physicians navigate the new product offering for the ACA marketplace:

    1. Even if physicians have a “standard” PPO contract with BCBSIL, this does not include the Blue Choice Preferred PPO product. Physicians need to have a separate Blue Choice Preferred PPO contract (or have admitting privileges at a participating hospital [see # 2 below]) to be included in the Blue Choice Preferred PPO network.
    2. Physicians who have admitting privileges at a Blue Choice Preferred PPO network hospital are automatically considered in-network for this plan. Physicians should verify that BCBSIL has the most up-to-date information regarding hospital admitting privileges that would qualify them for inclusion in the Blue Choice Preferred PPO network. Physicians can search here to see if their hospital is included in the network.
    3. If physicians do not have admitting privileges at a Blue Choice Preferred PPO hospital, they can request an application to join the network, or contact their BCBSIL provider network consultant.

    Questions? Call the ISMS Division of Member Advocacy at 800-782-4767 ext. 1470 or send an email.




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