Lawmakers Getting Involved in Springfield Clinic-Blue Cross Blue Shield of Illinois Fall Out

By Benjamin Cox on September 21, 2023 at 9:18am

Local lawmakers are now getting involved in a stand off between an insurance provider and a local healthcare clinic network.

It’s been 18 months since the announcement that Springfield Clinic would no longer would be considered “in network” for Blue Cross Blue Shield of Illinois health insurance plans. WTAX reports that the Blue Cross directory continues to show 98 Springfield Clinic providers as in-network when they are not.

Blue Cross Blue Shield’s parent company has already paid $1 million in fines to the Illinois Department of Insurance for failing to fix the network adequacy issues. Local lawmakers on both sides of the aisle know the fines are only a drop in the bucket for the insurance giant, and they want stronger penalties put in place.

54th District State Senator Steve McClure is working across the aisle with Democrat State Senator Doris Turner and Representatives Mike Coffey and Sue Scherer of Decatur in writing letters to the department demanding swift action. McClure recently told WAND News that he plans to meet with leaders from the department and Blue Cross Blue Shield soon.

Scherer has filed a bill to create transparency and harsher penalties for any insurance companies violating network adequacy standards. Her plan could require insurance groups to report any changes to their approved network plans within 15 days. Companies would face a $1,000 fine per day they fail to submit updated network plans. Scherer also believes insurance companies should audit their print and online directories for accuracy and make necessary corrections at least once every 90 days. The legislation could give the department the authority to file emergency rules to implement the federal standards for provider ratios, travel time and distance, and appointment wait times if they are more stringent than the state’s standards. Scherer hopes the bill gains traction in next month’s veto session.

Springfield Clinic operates 90 clinics in 20 Central Illinois counties. Since the split, Springfield Clinic has set up it own Advantage Health Plan to help some of the more than 110,000 people affected by the drop in network coverage.