SPRINGFIELD, Ill. (WAND) — Thousands of people with Blue Cross Blue Shield health insurance have called Springfield Clinic over the past 24 hours begging to see their doctors again. This comes as the Pritzker administration fined the insurance group $605,000 for violating state law over the past year. Springfield Clinic notes that they still haven't reached an agreement with the insurer.

Roughly 100,000 people in Central Illinois have struggled to find health care providers since Blue Cross dropped Springfield Clinic as an option under their PPO plan. While the Illinois Department of Insurance fined Blue Cross Blue Shield's parent company $605,000, this is the second time Health Care Service Corporation had to pay a fee for breaking the law. The organization gave Illinois $339,000 less than a year ago, and lawmakers are upset that nothing has changed.

"My constituents are suffering because of these things right now," said Sen. Steve McClure (R-Springfield). "Health care is extremely important and my constituents are entitled to have this coverage as part of their employer plans." 

Springfield Clinic leaders said Friday that some patients are waiting four to six months to see providers. Although, state law requires health insurance companies to have networks that meet proper time and distance standards for patients. 

"We need to co-exist. We have to co-exist," said Zach Kerker, the Vice President of Brand Experience & Advocacy for Springfield Clinic. "We have to co-exist in a way that puts patients first and allows them access to care." 

Kerker said patients are now calling and demanding refunds after they were forced to pay medical costs out-of-pocket. Many are also asking how Blue Cross is allowed to sell their plans if they don't have providers included in the network. McClure said Blue Cross needs to "get their act together" and appear for subject matter hearings before members of the Senate and House.

"Transparency is a good thing," McClure said. "And I think it might also allow for my constituents to testify and provide their take on what's been going on and how they've been affected by these issues." 

Still, Kerker said he would like to see the General Assembly pass legislation to give the state further enforcement capability over insurance providers. Springfield Clinic is advocating for more stringent requirements for insurance companies to meet to ensure there are enough providers included under any plan.

"Patients are the consumers that they're charged with protecting," Kerker said. "And I think that this is an important step, the fine that acknowledges that there were major issues with network adequacy and transparency. But I think that there are further questions like how are we going to protect patients from dealing with this again?"

A spokesperson for Blue Cross Blue Shield of Illinois said the organization worked with the state to resolve remaining areas of concern and develop plans to adjust some of their operational systems.

"Blue Cross and Blue Shield of Illinois is committed to providing its members with access to quality, cost-effective health care," said BCBSIL Senior Communications Manager Dave Van de Walle. "The Illinois Department of Insurance recently completed a routine market conduct exam focused on network adequacy. The Department's findings affirm BCBSIL's belief that our networks offer our members adequate access to care across every Illinois county." 

Van de Walle stated that market conduct exams are a normal part of doing business and the exams are one of the ways BCBSIL actively works with regulators to ensure they are best serving the needs of members.

The Illinois Department of Insurance stated Thursday that Health Care Service Corporation paid the fine and agreed to take corrective actions. However, this doesn't help patients who continue to pay astronomical co-pays or hold off on critical procedures because they aren't in the right provider network.

"That's not normal. It shouldn't be normal. You know, it's almost like they've been conditioned as a result of how long all of this has taken to think this is just the way that it's supposed to be," Kerker said. "And the reality is there is great health care in their backyard and there's no reason why they shouldn't have access to it." 

That is another reason why McClure wants both parties to discuss the issue in a public forum. He said everyone will be scratching their heads and left in the dark if Blue Cross doesn't come to the table. McClure stressed that health care needs can sometimes be extremely serious and urgent.

"If they're having to wait to see a doctor when they have this health care plan that's supposed to be outstanding and they're not receiving that coverage, they need to know why and that needs to be fixed immediately," McClure said. "Blue Cross needs to answer these questions in an open public hearing and I think the citizens of this state and this region deserve to hear what they have to say." 

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