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
Robbers hitting Chicago Lawn
Spread the love. From staff reports Police are warning the public about a robbery crew working the south end of Chicago Lawn. Crimes scenes include: 2500 block of West 73rd Street at 10:50 p.m. Monday, April 29. 7400 block of South Rockwell at 5:30 a.m. Tuesday, May 7. 7100 block of South Mozart at 6…
Moving scammers out there, BBB warns
Spread the love. By Better Business Bureau staff . Moving is always a stressful project. Throw in the threat of a moving scam, and things get even worse. Before hiring a moving company, careful research is necessary to avoid falling victim to a moving scam. These scams run the gamut from missing items, massive price…
Burglars hitting local businesses
Spread the love. From staff reports Police are alerting the public to what appears to be a crew of burglars hitting businesses across the city. A CPD alert noted 10 separate crimes. Three were committed against Southwest Side businesses on Friday, May 17: 7800 block of South Western at 12:11 a.m. 3300 block of West…
Rainbow Cone adds 4 new flavors
Spread the loveBy Bob Bong Chicago’s iconic Original Rainbow Cone has been evolving over the past few years. First, it joined forces with the folks at Buono Beef and expanded its presence from its original location in Beverly to offer cones at Buono Beef locations and a few stand-alone stores as well as food trucks.…
Park Lawn opens day program in Palos Heights
Spread the loveBy Kelly White Promoting inclusion and individuality, Park Lawn provides services that promote choice and access to community living for people with intellectual and developmental disabilities. The mission behind the organization focuses on encouraging people with disabilities to discover their passion, to take pride in their accomplishments, to live more independently and to…
EPCHS adds Emmy-winning actor Gary Sievers to Hall of Fame
Spread the loveEvergreen Park Community High School has added a name to its list of Hall of Famers. Gary Sievers, a 1968 EPCHS graduate who became well-known for his acting, public speaking, work in radio and television, community service, civic leadership and teaching, was posthumously inducted into the school’s Hall of Fame during the Honors…
Worth vehicle sticker applications ‘lost’ in the mail
Spread the loveBy Joe Boyle Worth Village Clerk Bonnie Price said that even though application forms for village vehicle stickers were sent out to the post office last month residents were still waiting to receive those applications. “We have been doing this for 15 years,” Price said during the Worth Village Board meeting May 7. “This…
Hunt killer in ‘drifting’ slaying
Spread the love. Police seek witnesses, video of 59/Western . By Tim Hadac Police are appealing to the public to help find those responsible for the slaying of a 20-year-old West Englewood man during a takeover of the intersection at 59th and Western at 3:21 a.m. Sunday, May 5. The victim–identified as Guillermo “Memito” Caballero…
Mom gets 20 years in babies’ murder
Spread the love. Stuffed her newborn twin boys in an alley garbage cart . By Tim Hadac The books closed this month on a double murder that shocked and sickened many in the Garfield Ridge area more than 20 years ago. Antoinette Briley, 44, pled guilty on May 7 to murdering her twin baby boys…
Neighbors
‘Anything that gets flushed’
Spread the love. MWRD shows how it treats wastewater . By Dermot Connolly What better activity for a sunny spring day than touring the world’s largest wastewater treatment plant—which many people did during the open house held Saturday at the MWRD’s Stickney Water Reclamation Plant in Cicero. To celebrate Chicago Water Week, the Metropolitan Water…
Giannoulias urges REAL ID signup
Spread the love Flanked by TSA Illinois Federal Security Director Jim Spriggs (left), Illinois Secretary of State Alexi Giannoulias is launching his office’s “Get Real Illinois” campaign to encourage Illinoisans to obtain a REAL ID. The campaign will raise awareness about the May 7, 2025 deadline and encourage residents to apply early to avoid problems…
Charge Garfield Ridge man with March murder
Spread the love. From staff reports . A 29-year-old Garfield Ridge man was charged with murder in connection with a slaying that occurred back in March. Alberto Rosas, of the 5200 block of South Central, was apprehended May 7 in the 6800 block of West Archer. Police said Rosas shot and killed 27-year-old Gustavo Suarez…
Beware, piano lovers, BBB says
Spread the love. By Better Business Bureau staff . If you’re in the market for a piano, then you know that the instrument can cost a hefty price and is not easy (or cheap) to transport. Scammers are targeting music lovers, businesses, schools, and churches with a new scam that claims to offer a piano…
Rashid calls college demonstrators ‘student heroes’
Spread the love. Rips Israel over “apartheid’ and ‘genocide’ . From staff reports The crisis in Palestine is taking a terrifying turn as the Israeli military is preparing to invade Rafah where more than one million Palestinians have been forced to after their homes in northern Gaza were destroyed, State Rep. Abdelnasser Rashid (D-21st) said…
Titanic memories haunt Worth Library
Spread the loveBy Kelly White This year marks the 112th anniversary of the Titanic’s fateful ship crossing. Bringing the ship back to life was the Worth Public Library on April 15 with a program called, The Haunted Titanic, with local historian Bob Trzeciak, who walked patrons through the history, the lasting impact, and why it…
Spring cleanup day in Bridgeview set for Saturday
Spread the loveBy Steve Metsch Any Bridgeview resident with clutter to clear will be busy Friday night, May 10. That’s when they will be putting all kinds of things on the parkway as the village prepares for its annual spring cleanup day set for Saturday, May 11. All items must be at the curb by…
Family of man killed in McCook struggling with his absence
Spread the loveBy Steve Metsch On what would have been his 37th birthday, the family of Morales Ricardo Lopez gathered at his grave in Evergreen Park Cemetery. Lopez, of Blue Island, was gunned down in McCook early Feb. 17, leaving behind a widow and three children. His family, other relatives and friends gathered at his…
Southwest Symphony presents ‘American Song Book’
Spread the loveFrom staff reports Southwest Symphony Orchestra will perform “The American Song Book” this weekend at Trinity College in Palos Heights. The performance will feature Grammy nominated Helen Welch under the direction of David Crane at 7:30 p.m. Saturday in Trinity Christian College’s Ozinga Auditorium. Welch will perform some of America’s best loved classics.…
Shoppers welcome back Evergreen Park Farmers Market
Spread the loveBy Joe Boyle Rain was forecast for the morning of May 2, but nothing could dampen the spirits of customers who dropped by the Evergreen Park Farmers Market. The large crowd that attended were instead greeted with mostly sunny skies. Beth Novotney, director of the Evergreen Park Office of Citizen Services that oversees…