With Blue Cross coverage change a month away, Springfield Clinic warns 100,000 patients [The State Journal-Register, Springfield, Ill.]

Oct. 16—Springfield Clinic criticized the "record profits" earned by Blue Cross and Blue Shield of Illinois' parent company during the COVID-19 pandemic in letters and emails this week to about 100,000 Blue Cross-covered patients who could lose access to their clinic doctors Nov. 17 and beyond.

"At a time when countless individuals, families and businesses in our communities have faced financial challenges and hardships, it is unimaginable that BCBSIL would terminate Springfield Clinic as an in-network provider," the letter says.

"Their decision will have a simple and direct impact on you — it will increase your out-of-pocket costs to see your Springfield Clinic provider beginning Nov. 17, 2021," the letter says.

Springfield Clinic, a for-profit business with more than 600 doctors and advanced-practice practitioners in 80 different medical specialties, has been in a contract dispute for months with Blue Cross, the state's largest insurance company, over reimbursement rates.

The lack of a resolution by Nov. 17 would result in higher out-of-pocket payments for patients covered by preferred-provider Blue Cross plans who use Springfield Clinic. The clinic, currently an "in-network" provider for Blue Cross, would change to an "out-of-network" provider.

Springfield Clinic officials declined to speak with The State Journal-Register about the most-recent letter. But they say on the clinic's website that they "do not anticipate a resolution" with Blue Cross and Blue Shield.

Clinic officials indicated on the website that contract terms backed by Blue Cross would hurt the clinic financially and make it harder to attract and retain doctors, especially specialists, in central Illinois and "restrict our ability to acquire the latest innovative treatments and technologies."

The clinic letter quotes a 2020 story in Crain's Chicago Business that says Blue Cross' parent company, Chicago-based Health Care Service Corp., saw a 14.5% increase in net income in the first half of 2020 compared with the first half of 2019.

Health Care Service Corp., which also operates Blue Cross plans in Texas, Montana, New Mexico and Oklahoma, saw its profits increase from $2.27 billion in 2019 to $3.98 billion in 2020, according to a financial report filed with the National Association of Insurance Commissioners.

The 75% increase in profits was part of a nationwide trend as patients delayed care during the COVID-19 pandemic and health insurance companies paid out less reimbursements for medical services.

Health Care Service Corp.'s profits have dropped since 2020 as more patients have resumed regular medical care.

The parent company's profits in the first quarter of 2021 were almost $1.13 billion, or 1.3% higher than the first quarter of 2020. Second-quarter profits for 2021 were $1.48 billion, or 45% below 2020's second-quarter level.

Krishna Ramachandran, Blue Cross' divisional senior vice president for health care delivery, wouldn't divulge details of contract talks but told the SJ-R he remains optimistic the dispute can be resolved.

"Obviously, it takes two to tango," he said Friday. "We've been in regular communication with them. ... Obviously, we value Springfield Clinic and the care that their doctors and providers give our members. We really hope they stay in our network."

Ramachandran wouldn't respond directly to Springfield Clinic's statements about Health Care Service Corp. profits but noted that Blue Cross and Blue Shield of Illinois' earnings are lumped in with several other Blue Cross entities.

He did say Blue Cross data indicate that the cost of care that central Illinois residents are paying through premiums paid by employers and workers is 16% higher than in the Chicago area.

Blue Cross is trying to hold down costs while maintaining quality in its network of providers, Ramachandran said.

Uncertainty about the situation is causing anxiety and frustration for local employers and their employees, according to Andrew Novaria, a health insurance broker at American Central Insurance Services in Springfield.

Most employers he works with plan to stick with their Blue Cross coverage even though many employees might have to leave their longtime doctors to avoid higher out-of-pocket medical expenses.

Some employers are looking for other health plan options so employees can retain their clinic providers, he said.

"Blue Cross is significantly less expensive than some of the other options out there," Novaria said. "People don't want to pay any more for health insurance than they are paying today."

Springfield Clinic wouldn't divulge anything about its finances or how it would be affected if most Blue Cross-insured patients left.

Novaria said he suspects the clinic, like many medical providers, saw revenues drop during 2020 as patients avoided the doctor's office and central Illinois joined other parts of the country covered by stay-at-home orders.

He said his plea to Springfield Clinic and Blue Cross officials is, "Just figure it out."

Affected Blue Cross members who don't want to pay higher out-of-pocket expenses after Nov. 17 would be wise to look into options now for in-network doctors outside Springfield Clinic, Novaria said. Otherwise, they could face a stampede of patients competing for slots to see new medical providers, he said.

"When these contract disputes get resolved, they don't get resolved until the last minute, and sometimes they don't get resolved," he said.

Springfield Clinic officials say in their letter that Blue Cross members are encouraged to consider "self-pay" options and contact the clinic's patient advocacy center at (217) 391-7086 for assistance.

Officials said patients can continue to see their clinic doctors using out-of-network benefits or contact their employers' benefit-plan administrators to determine whether they can switch plans and still see clinic providers on an in-network basis.

Patients can call Blue Cross to determine whether their ongoing treatment, for conditions such as pregnancy and cancer, qualifies for "continuity of care" coverage at the same rates after Nov. 17, clinic officials said.

As of Aug. 19, services at Springfield Clinic's outpatient Ambulatory Surgery and Endoscopy Center in Springfield became out-of-network for Blue Cross PPO members.

Plans not impacted and remaining in-network with the clinic include: BCBSIL Community Health Plan (Medicaid); BCBSIL Medicare-Medicaid Alignment Initiative (MMAI), BCBSIL HMO UnityPoint (Site 457) for Peoria only, and BCBS Medicare Supplements.

Contact Dean Olsen: [email protected]; (217) 836-1068; twitter.com/DeanOlsenSJR.

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