SPRINGFIELD, Ill. (WAND) — The vice president of Blue Cross Blue Shield of Illinois claims the insurance company doesn't have any regulatory issues going into Fiscal Year 2024. Although, Springfield Clinic leaders said they're disappointed Blue Cross wasn't transparent about ongoing problems with network adequacy.
Robert Miller's statement came during a hearing Tuesday morning with lawmakers on the Commission for Government Forecasting and Accountability. Meanwhile, thousands of people still can't see their Springfield Clinic doctors and specialists.
"It's been over a year and a half that we've been out of network. They kicked us out of network. That's fine. We get that," said Zach Kerker, Vice President of Brand Experience and Advocacy for Springfield Clinic. "But, you're misrepresenting whether or not Springfield Clinic providers are in-network and, in doing so, you're misleading patients to believe there is a larger network than there is."
Springfield Clinic told WAND News Tuesday that the Blue Cross directory continues to show 98 clinic providers as in-network that are actually out-of-network. There are at least five specialties where Blue Cross fails to meet network adequacy standards and four specialties that are close to violating the state's standards.
There are currently no providers available for rheumatology, radiation oncology, or allergy patients in the Blue Cross network. Insurance companies are also required to have 20 OB-GYNs in network, but BCBSIL only has nine available for patients. The state requires companies to provide five ophthalmologists in their network, but there is currently only one provider in the Blue Cross network.
"If you remove the Springfield Clinic providers listed on the online directory from some of the specialties, they have serious network adequacy concerns," Kerker said. "It begs the question whether they leave the providers in there in some of these specialties to represent that they have enough providers where they don't. I think that's a fair question, and we hear that from patients all the time.
This comes three weeks after Springfield Clinic sent a letter to the Illinois Department of Insurance demanding action. Kerker said there should be accountability beyond the $1 million in fines Blue Cross has already paid.
"Honestly, I don't know if that's intentional action on their behalf or incompetence," Kerker said. "But either way, patients are the ones who are being misled. We hear from them every day, coming in thinking that their providers are in-network when they're out-of-network. They're being billed opposite of what they're expecting, and there should be accountability for that."
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.
A spokesperson for the Illinois Department of Insurance said the agency is committed to ensuring that Blue Cross Blue Shield of Illinois comes into compliance with the network adequacy and transparency standards.
"The Department recently concluded a market conduct exam resulting in a $605,000 fine for Health Care Service Corporation, the parent company of Blue Cross Blue Shield of Illinois, for violating the Network Adequacy and Transparency Act, including findings related to updating provider directories," said IDOI Communications Director Caron Brookens.
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