Is BCBSIL Violating the ISMS-Initiated Network Adequacy Law … Again?

November 9, 2022

Last week Illinois Senator Doris Turner sent an urgent communication to the Illinois Department of Insurance (DOI) regarding her concerns about Blue Cross and Blue Shield of Illinois (BCBSIL)’s inadequate health plans being offered for 2023.

Senator Turner says her constituents are currently in the middle of the open enrollment process for 2023 and that they are being misled by BCBSIL’s online physician directory. The senator contends that to make an informed decision, consumers need accurate, up-to-date information that reflects in-network providers participating in the health plans that her constitutes are considering. BCBSIL asserts that its provider networks are adequate under the ISMS-initiated Network Adequacy and Transparency Act (NAT Act).

A network adequacy filing for BCBSIL is currently under review by the DOI.

As you may recall, the Springfield Clinic was dropped as an in-network provider by BCBSIL in November of  2021 without proper notice, suddenly impacting access for thousands of individuals to one of the largest networks of primary care, specialty physicians and ambulatory care services in Central Illinois, including rural communities.

As a result, the DOI assessed a fine of $339,000 to the parent company of BCBSIL in March 2022 for violating the material change notice requirement under the state’s NAT Act and failing to submit requested information following the terminating of its contract with the Springfield Clinic. This was the first time ever that the DOI fined an insurer under this Act.

Last month the DOI fined Celtic Insurance Company $1.25 million for violating Illinois’ NAT Act and the federal Mental Health Parity and Addiction Equity Act.

If you believe a health insurance company is violating the NAT Act or any other law or regulation, please file a complaint with the DOI. When appropriate, encourage your patients to also file complaints. These complaints drive the DOI to take action. Need help? Contact the DOI’s Office of Consumer Health Insurance toll free at 877-527-9431.

To learn more, access ISMS’ resource Health Insurance Complaints? The Department of Insurance Needs to Know.

Questions? Please contact the ISMS Health Policy Research and Advocacy team by email.

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