Illinois fines Blue Cross Blue Shield for network inadequacies

The report from IDOI was nearly two-and-a-half years in the making and found a list of violations by HCSC, including a failure to list all available specialty providers for health maintenance plans in its provider directories or note that authorization may be required to access some providers.

The corporation has already paid the fine, according to IDOI, and has agreed to take corrective action based on the exam findings.

"The law requires health insurance companies to have a provider network that meets proper time and distance standards for consumers to receive care, as well as up-to-date, accurate directories identifying which providers are in-network," IDOI Director Dana Popish Severinghaus said in a statement. "When companies under our regulatory authority are in violation of insurance laws meant to protect consumers, we will take action."

This review of Blue Cross Blue Shield of Illinois, the state's largest health benefits provider, included an examination of company operations and management, provider relations, consumer complaints and network adequacy.

It was the second-time Blue Cross had been fined for violating the Network Adequacy and Transparency Act, following a $339,000 fine in 2022. The act became a state law in 2017.

IDOI says it will continue its oversight of the company to ensure it adheres to the changes it promised. Otherwise, the department could issue additional fines.

Contact Patrick Keck: 312-549-9340, [email protected], twitter.com/@pkeckreporter.