Lawmakers, Department of Insurance focus on Blue Cross, Springfield Clinic controversy
By PETER HANCOCK
Capitol News Illinois
phancock@capitolnewsillinois.com
SPRINGFIELD – An ongoing contract dispute between a major health insurance company and a large health care provider in Springfield is drawing the attention of both state lawmakers and the state Department of Insurance.
Blue Cross Blue Shield of Illinois has been under scrutiny since July after it failed to reach an agreement with Springfield Clinic to be part of the insurance company’s network. As a result, policy holders who receive care at that clinic have been forced to change providers or pay higher out-of-network copayments.
Springfield Clinic is a private, independent, for-profit health care provider that serves people in central Illinois. About 55,000 of those are Blue Cross members, according to Blue Cross.
On Monday, the Illinois Department of Insurance fined BCBS’s parent company, Health Care Service Corp., $339,000 for failing to notify the agency of a material change in its network, the first such fine the agency has ever issued since Illinois enacted the state’s Network Adequacy and Transparency Act in 2017.
Under that law, insurers are required to report to the agency any material change to an approved network plan within 15 days after the change occurs.
The official break between BCBS and Springfield Clinic took effect July 1 for its Health Maintenance Organization plans, and Nov. 17 for its Preferred Provider Organization plans. The company, however, did not formally notify the department of that change until earlier this month, resulting in a $1,000 fine for each day the filings were late.
For its part, BCBS has said the contract dispute centers on reimbursement rates. It says Springfield Clinic was seeking a 75 percent increase in its rates, which the insurance company says are already above average for the region and the state.
A spokesperson for Springfield Clinic did not immediately respond to a request for comment.
In a statement, BCBS senior vice president Krishna Ramachandran characterized the late filings as a misunderstanding.
“Though we had a reasonable and well-informed opinion that Springfield Clinic’s decision to leave our network did not trigger any network change filing, when the Department requested one within the past few weeks, we promptly complied,” he said. “As we evaluate the Department’s decision, we will continue to work collaboratively and in compliance with applicable laws and regulations while ensuring access, affordability and quality in health care for the more than 8 million Illinoisans we cover.”
The fine itself has proved to be controversial as well because although the 2017 law authorizes the Insurance Department to levy fines for noncompliance, the agency has never adopted formal administrative rules spelling out how the fines would be calculated and assessed.
That was the subject of discussion Tuesday at a meeting of the Joint Committee on Administrative Rules, or JCAR, a legislative committee that exercises oversight of the administrative rulemaking process, where Republicans questioned why it has taken so long to promulgate rules.
Insurance Department general counsel Joanna Coll explained that the agency is responsible for enforcing both state and federal network adequacy standards. The federal standards apply to policies sold through the Affordable Care Act marketplace.
But she said previous administrations at both the state and federal level showed little interest in regulatory enforcement.
“So the federal (Centers for Medicare and Medicaid Services) initially under the previous administration, they did not want to engage in network adequacy at all and had actually forced the feds to backtrack on the situation,” she said. “Under President Biden there has been a renewed interest in federal regulations on this topic. So, we have been very actively trying to dance to keep up with the updating federal regulations and make sure that they are enforced in full under the Illinois law that you all worked so hard to pass.”
Meanwhile, both BCBS and Springfield Clinic were scheduled to appear Tuesday afternoon before the House Insurance Committee. But that meeting was canceled because regular floor action in the House was delayed that day due to an extended closed-door Democratic caucus meeting that lasted over three hours.
A spokeswoman for the House Democrats said in an email that the hearing would be rescheduled but that an exact time and day has not been arranged between all the parties.
Capitol News Illinois is a nonprofit, nonpartisan news service covering state government and distributed to more than 400 newspapers statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.
Local News
Southwest Regional Publishing basketball roundup, Dec. 4-5
Dec. 5 Boys TF North 67, Argo 52: Kassam Saleh scored 15 for the Argonauts (2-3, 0-1 South Suburban Red). Girls Reavis 49, Tinley Park 25: Emily Grochola scored 13 points to lead the Rams (4-2, 1-0 South Suburban Red) past the Titans. Shepard 52, TF South 49: Jessica Manley’s 21 points helped the Astros…
Richards’ Myles Mitchell signs with North Dakota State
Myles Mitchell is one of the state’s premier running backs, with a bright future with one of the nation’s best FCS programs. But the path hasn’t always been easy for the Richards senior, who made his college commitment to North Dakota State official during a signing ceremony on Dec. 4. “Eighth grade was kind of…
Brad Johnson Jr. finds range, leads Curie past Lane
Facing what was literally a tall task against Lane on Dec. 5, Curie was in serious need of a spark. Brad Johnson Jr. provided it. Led by 6-foot-10 Penn recruit Dalton Scantlebury, Lane is one of the area’s biggest teams. Curie was undersized by comparison in the Public League Red Shield opener and trailed by…
Orland Park Christmas parade lights up the season
“Even in the cold, this parade warms your heart,” said Cathy Garner, an Orland Park resident who joined her twin daughters in Sunday’s Christmas Parade. With temperatures hovering at 25 degrees but feeling like 15 due to the wind chill, residents bundled up in blankets, winter coats, and hats for the beloved tradition. The parade…
Southwest Regional Publishing basketball roundup, Dec. 2-3
Dec. 3 Boys Andrew 72, Argo 50: Darron Greer Jr. led the Argonauts (2-2) with 14 points. Evergreen Park 70, U-High 58: Keshaun Vaval had 25 points to lead the Mustangs (3-1). Lonnie Mosley added 17 points and Camryn Dandridge grabbed 14 rebounds. Lemont 65, Stagg 35: Omar Barakat scored 17 for the Chargers (0-4).…
Football signing day: Local recruits
Here is a list of football players in the Southwest Regional Publishing coverage area committed to Division I schools. Please email additions or corrections to mikeclarkpreps@gmail.com. Brother Rice Tyler Lofton, RB, Illinois State Jimmie Maxson, WR, North Dakota Charlie Stec, Edge, Western Illinois Lyons Tyler Chambers, OL, Northern Illinois Travis Stamm, WR, Illinois State Marist…
Michael Oliver Jr. offers veteran presence for new-look Curie
There are a lot of new faces at Curie this winter. Gone are the five senior starters from a 31-3 team that won the Public League title and lost by two points to eventual Class 4A champion Homewood-Flossmoor in the Elite Eight. But veteran coach Mike Oliver is back and so is his son, junior…
Boys basketball notebook: Kassam Saleh, Argo aiming high this season
Kassam Saleh is ready to set the tone for Argo. “As time goes on you gain the most experience on the team and become that leader for everyone else,” said Saleh, a senior guard. “They follow you.” The Argonauts finished runner-up in the John McBride Classic at Stagg, falling 50-44 to Plainfield South on Nov.…
Neighbors
Southwest Regional Publishing basketball roundup, Dec. 4-5
Dec. 5 Boys TF North 67, Argo 52: Kassam Saleh scored 15 for the Argonauts (2-3, 0-1 South Suburban Red). Girls Reavis 49, Tinley Park 25: Emily Grochola scored 13 points to lead the Rams (4-2, 1-0 South Suburban Red) past the Titans. Shepard 52, TF South 49: Jessica Manley’s 21 points helped the Astros…
Richards’ Myles Mitchell signs with North Dakota State
Myles Mitchell is one of the state’s premier running backs, with a bright future with one of the nation’s best FCS programs. But the path hasn’t always been easy for the Richards senior, who made his college commitment to North Dakota State official during a signing ceremony on Dec. 4. “Eighth grade was kind of…
Brad Johnson Jr. finds range, leads Curie past Lane
Facing what was literally a tall task against Lane on Dec. 5, Curie was in serious need of a spark. Brad Johnson Jr. provided it. Led by 6-foot-10 Penn recruit Dalton Scantlebury, Lane is one of the area’s biggest teams. Curie was undersized by comparison in the Public League Red Shield opener and trailed by…
Orland Park Christmas parade lights up the season
“Even in the cold, this parade warms your heart,” said Cathy Garner, an Orland Park resident who joined her twin daughters in Sunday’s Christmas Parade. With temperatures hovering at 25 degrees but feeling like 15 due to the wind chill, residents bundled up in blankets, winter coats, and hats for the beloved tradition. The parade…
Southwest Regional Publishing basketball roundup, Dec. 2-3
Dec. 3 Boys Andrew 72, Argo 50: Darron Greer Jr. led the Argonauts (2-2) with 14 points. Evergreen Park 70, U-High 58: Keshaun Vaval had 25 points to lead the Mustangs (3-1). Lonnie Mosley added 17 points and Camryn Dandridge grabbed 14 rebounds. Lemont 65, Stagg 35: Omar Barakat scored 17 for the Chargers (0-4).…
Football signing day: Local recruits
Here is a list of football players in the Southwest Regional Publishing coverage area committed to Division I schools. Please email additions or corrections to mikeclarkpreps@gmail.com. Brother Rice Tyler Lofton, RB, Illinois State Jimmie Maxson, WR, North Dakota Charlie Stec, Edge, Western Illinois Lyons Tyler Chambers, OL, Northern Illinois Travis Stamm, WR, Illinois State Marist…
Michael Oliver Jr. offers veteran presence for new-look Curie
There are a lot of new faces at Curie this winter. Gone are the five senior starters from a 31-3 team that won the Public League title and lost by two points to eventual Class 4A champion Homewood-Flossmoor in the Elite Eight. But veteran coach Mike Oliver is back and so is his son, junior…
Boys basketball notebook: Kassam Saleh, Argo aiming high this season
Kassam Saleh is ready to set the tone for Argo. “As time goes on you gain the most experience on the team and become that leader for everyone else,” said Saleh, a senior guard. “They follow you.” The Argonauts finished runner-up in the John McBride Classic at Stagg, falling 50-44 to Plainfield South on Nov.…