OSF, Blue Cross to part ways; open to further discussion

Oct. 11--BLOOMINGTON -- A contract dispute means OSF HealthCare hospitals no longer will participate in the Blue Cross Blue Shield PPO network, effective Jan. 1, unless the two organizations can come to a new agreement, OSF said Tuesday.

The change would affect OSF HealthCare St. Joseph Medical Center in Bloomington and OSF HealthCare Saint James-John W. Albrecht Medical Center in Pontiac, but not physicians' offices. That means that Illinoisans with Blue Cross Blue Shield PPO health insurance wouldn't be able to access in-network care at OSF Illinois hospitals, with the exception of the Alton hospital.

Advocate Health Care hospitals in Central Illinois are not affected.

The action began when Blue Cross Blue Shield of Illinois announced plans to drop three, large OSF hospitals from its network. OSF responded by terminating Blue Cross agreements with most of its other hospitals.

But OSF said in a prepared statement "OSF is open to future discussions with BCBSIL to avoid a disruption to patients."

And Blue Cross Blue Shield spokeswoman Colleen Miller said "We are open to continuing contract discussions with the goal of reaching an agreement that benefits our members and customers."

"All of OSF HealthCare is participating in the Blue Cross and Blue Shield PPO network through the end of 2017," OSF clarified.

The termination would impact the following Blue Cross products: Commercial, BCBS PPO (preferred provider organization), all BlueChoice and EPO (exclusive provider organization) products.

Providers from OSF HealthCare Medical Group, OSF HealthCare Cardiovascular Institute, OSF HealthCare Illinois Neurological Institute and other OSF ancillary services are unaffected at this time, OSF said.

"We are disappointed and concerned about the decision by BCBSIL," OSF said. "We hope they realize the value of having OSF hospitals in network for their members."

Individuals who wish to switch to new plans for 2018 may do so during health insurance open enrollment this fall. Employees whose employers are not participating in open enrollment this fall should contact their employer's human resources department.

"Our OSF hospitals are participating in most other national and local managed care plans," OSF said. OSF's website (www.osfhealthcare.org) lists plans that OSF is participating in at this time.

Lisa Parro, public affairs director for Advocate BroMenn Medical Center in Normal and Advocate Eureka Hospital in Eureka, said "Advocate BroMenn Medical Center and Advocate Eureka Hospital and our providers remain in the Blue Cross Blue Shield of Illinois network. With more than 450 physicians and 25 sites of care across Central Illinois, we stand ready to continue to meet the needs of all individuals in the communities we serve."

The action began Oct. 2 when Blue Cross Blue Shield of Illinois announced plans to drop three OSF hospitals -- including OSF HealthCare Saint Francis Medical Center in Peoria -- from its network, effective Jan. 1, OSF said.

Blue Cross Blue Shield's PPO and BlueChoice contracts with the three hospitals "no longer serve BCBSIL's aim to continue to broaden our members' access to network providers and further enhance our network and product offerings," Miller said. Miller added that Blue Cross Blue Shield was committed to "creating and designing networks that balance access and affordability of care."

By removing these hospitals from its network, Blue Cross eliminated referral centers and access to critical care, reducing OSF's ability to care for the sickest patients, OSF said. That action forced OSF to terminate BCBSIL agreements with most of its other hospitals.

"OSF HealthCare has repeatedly stated it would accept a larger network but can't afford to provide BCBSIL the same reduced rates that were in place as part of a smaller network," OSF said.

Follow Paul Swiech on Twitter: @pg_swiech

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