Springfield Clinic Doctors Testify at House Committee Hearing on Dispute with BCBSIL
March 31, 2022
This past Wednesday, lawmakers heard from the Illinois Department of Insurance (DOI), Blue Cross Blue Shield of Illinois (BCBSIL) and physicians all on the same subject: the insurer terminating its contract with Springfield Clinic. During this Illinois House State Government Administration Committee hearing, members of the committee aimed to learn more about the dispute and encourage a quick resolution to help alleviate the issues that patients are now experiencing.
Two doctors from Springfield Clinic spoke passionately about the difficulty of not being able to see their patients and how they were trying to help them find in-network care. The doctors found that the BCBSIL provider directories were significantly inaccurate. One doctor testified that a physician that trained her and who retired many years ago was listed in BCBSIL’s directory as someone who is taking new patients. The insurer’s termination of the contract also impacts Springfield Clinic’s ability to recruit new doctors, which is already a challenging prospect in rural Illinois.
However, the director of the DOI stated that the Department does enforce the Network Adequacy and Transparency Act (NAT Act), legislation initiated by ISMS, which took effect Jan. 1, 2019. And the DOI did confirm that BCBSIL terminating Springfield Clinic did constitute a “material change,” which is why the DOI assessed the insurer a fine of $339,000. The director also indicated that the DOI would file rules for the NAT Act the next day (March 31, 2022), one day before the deadline of April 1.
When representatives from BCBSIL were up to testify, they said that negotiation specifics with Springfield Clinic were confidential and they could not provide financial details. Regarding the poor data in the provider directories, instead of acknowledging responsibility, the representatives attempted to blame doctors for not informing them of changes.
While much was uncovered, specifics pertaining to the contract negotiations were either unknown or deemed confidential. One committee member brought up at the end that so much is on the backs of the patients. For example, while patients are in the middle of a health crisis, they are supposed to report any insurance issues to the DOI. For patients who qualify for the continuity of care – those who may be experiencing debilitating health issues – the patients themselves must contact BCBSIL to get “approval” first for continuity of care.
ISMS will continue to keep members apprised of further developments in this dispute between BCBSIL and Springfield Clinic.
As we go to press, ISMS has learned that Steve Hamman is no longer president of BCBSIL.
If you have questions, please contact ISMS Senior Vice President of State Legislative Affairs Erin O'Brien by email