BCBSIL, Springfield Clinic end impasse

SPRINGFIELD — Blue Cross and Blue Shield of Illinois (BCBSIL) and Springfield Clinic announced Friday that they have struck an agreement to end a two year impasse and return the clinic's doctors to in-network status.

The five-year agreement takes effect Jan. 1. Springfield Clinic said in a statement that BCBSIL patients who wish to establish in-network care should call during normal business hours or schedule an appointment after Dec. 26.

In a statement, the state's largest health insurer said it was "glad" to have Springfield Clinic back in the fold "as part of an agreement that preserves access to quality health care for our members and employer groups."

More details about the agreement were not immediately disclosed.

The standoff began in November 2021, when BCBSIL terminated Springfield Clinic as an in-network provider for all of its preferred provider organization (PPO) health care plans due to a dispute over reimbursement rates.

This impacted up to 100,000 patients with Blue Cross Blue Shield coverage accessing Springfield Clinic for care. The for-profit clinic has more than 650 doctors and facilities that spread across a 20-county coverage area in Central Illinois.

Though mostly concentrated around the capital city and the surrounding area, Springfield Clinic has three facilities in Decatur as well as facilities in Effingham, Moweaqua, Neoga and Taylorville, among other communities.

Residents across the region are often referred to the clinic's more than 80 specialists.

The dispute between the insurer and clinic was public and often nasty, with the two sides trading barbs over the breakdown in coverage and subsequent inability to make progress in negotiations.

It also exposed gaps in BCBSIL's network as thousands of patients scrambled to find in-network care through other providers.

The Illinois Department of Insurance has fined BCBSIL three separate times totaling nearly $1.2 million in the past two years for violating the state's Network Adequacy and Transparency Act for not maintaining accurate provider directories.

The dispute spilled over into the state Capitol, where legislators in 2022 grilled the insurance company over their alleged "ghost network" of providers. A legislative effort to tighten enforcement of network adequacy standards ultimately fizzled, however.

State Rep. Sue Scherer, D-Decatur, has filed similar legislation this year.

Scherer called the agreement "the best Christmas present," adding that she "couldn't be happier for my constituents."

"After years of mediation and discussion, I am proud of the agreement that Blue Cross Blue Shield and Springfield Clinic were able to reach," Scherer said. "Still, there's more work to be done. And I will never stop fighting to hold big health insurance companies accountable."

contact brenden moore at brenden. [email protected]. Follow him on Twitter at @brendenmoore13.