Blue Cross announces PPO change

By Gary Scott on December 17, 2015 at 12:05pm

Some West Central Illinoisans who rely on Blue Cross Blue Shield may be affected by a recently-announced change in coverage.

Blue Cross will discontinue its “Broad” Preferred Provider Organization plan in 2016. The Broad PPO was offered in 2014 and 2015. BCBS Illinois spokesman Michael Deering says the plan is being discontinued for individual purchasers of insurance, but will still be available for small business and employer groups.

“That network literally included every hospital in the State of Illinois, so it wasn’t exactly a preferred network. That particular network just became- after we assessed two years worth of medical claims costs, calculating the actual cost and the pricing- unsustainable,” says Deering.

“The new PPO is called Blue Choice Preferred PPO, and it is narrower. It probably has about 125 hospitals, but we did ensure that it had coverage for every county in the State of Illinois.”

The decision impacts about 173-thousand insurance holders, most of which Deering says are in the Chicago area.

Deering says insurance holders should check to see if a physician or doctor falls under the current network. Although Passavant Area Hospital is included in the new PPO that replaces the Broad plan, he notes it doesn’t mean all practitioners at the hospital are included.

“It never means that, because for the most part, hospitals in Illinois do not have fully-employed medical staff. So, most of them are independent physicians that have privileges at each hospital,” he says. “So, it’s always important to check what you’re doctor takes in terms of health care coverage.”

Deering says you can see which hospitals are included in the Blue Choice Preferred PPO plan by using the “provider finder” tool on the Blue Cross Blue Shield Illinois website.

Memorial Medical Center in Springfield, Blessing Hospital in Quincy, and Jersey Community Hospital are included, but OSF St. Francis Medical Center in Peoria is not. However, that hospital is covered in the expansion of the Blue Precision HMO plan.

Deering says anyone affected by the Broad PPO plan elimination who now wants to find a new insurance provider can take advantage of a special enrollment period granted by the State of Illinois that lasts until the end of February.

He adds the Obama administration just yesterday extended the deadline to sign up for insurance coverage starting on January 1st to midnight tonight.