OSF optimistic that dispute with Blue Cross will be resolved

Oct. 12--BLOOMINGTON -- Thousands of Central Illinoisans could be affected if OSF HealthCare and Blue Cross Blue Shield of Illinois don't resolve their contract dispute by Jan. 1, but OSF officials remained optimistic Wednesday there would be a resolution.

"We are very hopeful that they (Blue Cross Blue Shield) will keep the door open," said Shelli Dankoff, OSF media relations coordinator. "We certainly have. We remain optimistic that this will be resolved."

"It is our hope that BCBS (Blue Cross Blue Shield) will realize the value of having OSF hospitals in its network for its members and enter into a new agreement," said Randy Billings, OSF senior vice president of population Health.

Blue Cross Blue Shield spokeswoman Colleen Miller said Wednesday the insurer wouldn't go beyond it's Tuesday statement, which included: "We are open to continuing contract discussions with the goal of reaching an agreement that benefits our members and customers."

OSF said Tuesday that OSF Illinois hospitals -- including OSF HealthCare St. Joseph Medical Center in Bloomington, OSF HealthCare Saint James-John W. Albrecht Medical Center in Pontiac, OSF HealthCare Saint Francis Medical Center in Peoria and OSF HealthCare Children's Hospital of Illinois -- would no longer participate in the Blue Cross Blue Shield PPO network, effective Jan. 1, unless the two organizations can come to a new agreement.

Blue Cross Blue Shield is the largest commercial health insurance company in Illinois. The insurer didn't say how many members are OSF patients.

"BCBS is the largest nongovernmental (not including Medicaid and Medicare) payer for the OSF providers, including hospitals," Billings said.

Blue Cross members would still be able to access care at OSF hospitals but would pay out-of-network rates, Dankoff said.

Outpatient services at non-hospital OSF facilities -- including doctor's offices and clinics -- would not be affected by the change, she said.

However, inpatient services and in-hospital outpatient services -- including rehabilitation, ambulatory surgery, diagnostic testing, audiology and sleep studies -- would be affected, Dankoff said. Out-of-network rates would apply.

Retirees with Medicare as their primary coverage and Blue Cross Blue Shield as their supplementary coverage apparently wouldn't be affected, but retirees are urged to check with Blue Cross.

Blue Cross Blue Shield is the insurer for all Country Financial employees and for non-Medicare retirees covered under Country's group medical plan, said Country spokesman Christopher Stroisch,

"Our group medical provider, Blue Cross Blue Shield of Illinois (BCBSIL), notified us their current OSF HealthCare contracts will end Jan. 1, 2018," Stroisch said. "BCBSIL officials have told us it's their intention to renegotiate the OSF contracts and they hope to do so before the actual termination date of the existing relationships. However, it was necessary under the existing contracts that 90-day notice be given."

State Farm spokeswoman Missy Dundov said, "It is too early to tell what, if any, impact this will have on our associates' health care needs as OSF and BCBSIL said they are open to continued negotiations."

Individuals who wish to switch health insurance plans for 2018 may do so during open enrollment this fall. OSF's website lists plans in which OSF is participating.

Blue Cross said it wants to broaden its members access to other hospitals, balancing access with affordability.

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

Blue Cross responded by announcing plans to remove OSF hospitals in Peoria, Rockford and Galesburg from its network. OSF then terminated its BCBSIL agreements with most of its other hospitals because eliminating the three larger hospitals that provide critical care would reduce OSF's ability to provide a continuum of care, Dankoff said.

Follow Paul Swiech on Twitter: @pg_swiech

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