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    Blue Cross and Blue Shield Insurance Coverage Updates

    Complaint Options for Reimbursement

    (Updated 3/30/22) Springfield Clinic patients who are on file with BCBSIL PPO as their primary insurance may receive this notification via email and/or letter.

    Dear Patient,

    You are receiving this letter because you may be eligible for some reimbursement of your health care claims. Specifically, legislators have recently called for Blue Cross Blue Shield of Illinois (BCBSIL) to reimburse patients who have been treated as out-of-network by BCBSIL for services provided by Springfield Clinic. These calls have come as the result of BCBSIL terminating Springfield Clinic as an in-network provider for their PPO members, and doing so without the required network adequacy to meet patient need. To be eligible for reimbursement, you may need to file a complaint with one of two regulatory agencies.

    If you think your claim has been processed incorrectly by BCBSIL or if you’re having issues getting appointments with providers outside Springfield Clinic, we encourage you to take the following steps.

    NOTE: Ask your HR administrator if your plan is fully-funded or self-funded so you know which path to take.

    Fully-Funded Plan

    If you have a fully-funded plan, file a complaint with the Illinois Department of Insurance.

    Contact via Email: 
    [email protected]
    Call IDOI with questions: 877.527.9431 (Press 4 for health insurance questions.)

    Self-Funded Plan

    If you have a self-funded plan, file a complaint with the U.S. Department of Labor.

    Call Employee Benefits Security Administration (EBSA): 1.866.444.3272  
    (Press 2 to talk to your regional office.)

    Need Help? Contact Springfield Clinic Patient Advocate Team

    If you need help with this process, please contact the Springfield Clinic Patient Advocate Team at 217.391.7086 with any questions about your bills or insurance claims. Hours are Monday-Thursday 8 a.m.- 7 p.m., Friday 8 a.m.-5 p.m. and Saturday 8 a.m.- 12 p.m.

    What Can I Do?

    1. If Springfield Clinic is out-of-network for your insurance plan, call us to discuss whether our self-pay options may help you manage costs. Our Patient Advocate Center hours are are Monday-Thursday 8 a.m.- 7 p.m., Friday 8 a.m.-5 p.m. and Saturday 8 a.m.- 12 p.m.. Call 217.391.7086 to get your questions answered and discuss financial options.

    2. Continue to see your Springfield Clinic provider using your out-of-network benefits. Find out from your HR benefit plan administrator what your BCBSIL out-of-network benefits will be after Nov. 17, 2021*.

    3. Talk to your employer’s HR benefit plan administrator to learn more about your in-network participation options. We accept more than 13 major health care insurance plans, and you can view all available plan options at www.springfieldclinic.com/insurance

    4. Explore Continuity of Care coverage with BCBSIL if your ongoing treatment (i.e., pregnancy, cancer treatments) may qualify for this exception during this transition time.

    5. If you have any questions about your bill, please contact our Patient Advocate Center at 217.391.7086 and check out FAQs below including information on the no surprise billing act and how it impacts our patients.

    *Some employers have made arrangements allowing their employees currently enrolled in a BCBSIL PPO plan to continue accessing the Ambulatory Surgery and Endoscopy Center (ASC) and seeing their Springfield Clinic provider at in-network cost sharing rates after Nov. 17. Contact your HR administrator to determine if your employer has made such an arrangement.

    FAQs

    Frequently asked questions about Blue Cross and Blue Shield of IL (BCBSIL) PPO

    What paperwork do I need to complete to schedule a procedure at an in-network facility with an out-of-network provider?

    Due to Illinois law and new federal laws, effective Jan. 1, 2022, there is special paperwork that needs to be completed prior to receiving certain non-emergency services from an out-of-network provider at an in-network hospital.  

    Before your procedure is scheduled there are two critical pieces to proceed: the cost estimate and the consent form.  

    To get started, please follow these steps: 

    1. Your clinical team will initiate the process by notifying the Patient Advocacy Center (217.391.7086) of your upcoming procedure. 

    1. The Patient Advocacy Center will provide you with: 

    • Notice of Springfield Clinic’s out-of-network status 

    • Good Faith Estimate of charges for the service or procedure at the hospital 

    • Good Faith Estimate for self-pay patients 

    • Consent form (Consent form indicates that you are aware of your doctor’s out-of-network status and that you agree to the care. It must be signed and returned to Springfield Clinic before the service or procedure is scheduled.)  

    1. Once you return the completed and signed forms to the Patient Advocacy Center, they will notify your doctor. 

    1. Your clinical team will then: 

    • Provide you with the date, time and location of your scheduled procedure 

    • Provide you with additional steps or actions that need to occur prior to the service, procedure, or surgery 

    • Request an out-of-network prior authorization from your insurance company, if needed, for your service or procedure 

    Our Patient Advocacy Center is ready to help should you have any questions along the way. Please call 217.391.7086 with any questions about your bills or insurance claims. Hours are Monday-Thursday 8 a.m.- 7 p.m., Friday 8 a.m.-5 p.m. and Saturday 8 a.m.- 12 p.m.

    How is my bill impacted when I receive care from an out-of-network provider at an in-network facility?

    Patients who receive emergency services and other out-of-network non-emergency services (ex. radiology, laboratory, pathology, etc.) at an in-network facility or hospital are protected by both Federal and Illinois statutes. These laws require the patient’s benefit cost sharing amounts (ex. co-pay, deductible, co-insurance) to be limited to the amount they would have paid if the out-of-network provider was in-network with the patient’s health plan. In other words, the patient will not be financially penalized for the emergency and diagnostic care they receive from an out-of-network provider when the services are received within the in-network facility or hospital.   

    Links to the pertinent legislation are provided below. 

    If you have questions or believe there is an error in a bill from Springfield Clinic, please contact the Patient Advocacy Center (217.391.7086) to discuss your specific concern.  Hours are Monday-Thursday 8 a.m.- 7 p.m., Friday 8 a.m.-5 p.m. and Saturday 8 a.m.- 12 p.m.

    Will a patient be billed for a COVID-19 test if they elect the self-pay option when their insurance is out-of-network?

    No. COVID-19 test charges will process through insurance as covered charges and will not be billed to the patient regardless if they are in-network  or out-of-network with their plan.

    Springfield Clinic will bill the COVID-19 test to ANY valid health insurance payer based on current industry practices.

    Why is Springfield Clinic no longer participating with Blue Cross and Blue Shield of IL (BCBSIL) PPO* plans?

    Springfield Clinic has been notified that Blue Cross Blue Shield of IL will be terminating all existing commercial PPO plans for Springfield Clinic providers at all locations. If you have one of these plans, this means that, after the effective dates below, Springfield Clinic will be an out-of-network provider for your BCBS plan. There are some Medicare/Medicaid plans that are exceptions.  

    We will continue to provide your patient care, however it would be through your plan’s out-of-network coverage.

    • Effective Aug. 19, 2021, Springfield Clinic will be out-of-network for all procedures scheduled at our outpatient Ambulatory Surgery and Endoscopy Center (ASC). If you have a procedure currently scheduled for after Aug. 19, 2021, Springfield Clinic ASC staff will be contacting you to discuss your surgery options. 

    • Effective Nov. 17, 2021, BCBS will be out-of-network for primary, specialty and urgent care and all additional medical services and lab services at all Springfield Clinic locations.  
      *Some employers have made arrangements allowing their employees currently enrolled in a BCBSIL PPO plan to continue accessing the Ambulatory Surgery and Endoscopy Center (ASC) and seeing their Springfield Clinic provider at in-network rates after November 17. Contact your HR administrator to determine if your employer has made such an arrangement.

    Is there any chance of resolution with BCBSIL regarding the PPO or Choice plans?

    As a current patient who is covered under a Blue Cross and Blue Shield of Illinois (BCBSIL) PPO health plan, you will soon be out-of-network at all Springfield Clinic locations. This is a direct result of BCBSIL’s recent decision to terminate Springfield Clinic as an in-network provider for all of its commercial PPO plans. 

    It’s critical that you understand that we do not anticipate a resolution with BCBSIL.

    For 82 years, we have been your physicians. We may have cared for your parents and grandparents, and our hope is to care for your children and grandchildren as well. 

    In recent years, communities like ours across the nation have seen access to quality care deteriorate. While the decision to terminate in-network coverage was not made by us, it impacts more than 100,000 patients who rely on our care. Our promise to you is to advocate for partnerships that support health care in central Illinois today and in years to come. To that end, we must reject terms that:

    • Limit access to a wide range of specialty care that would require our patients to travel to metropolitan areas to receive treatment.

    • Threaten the care we provide to 20 rural counties.

    • Restrict our ability to acquire the latest innovative treatments and technologies.

    • Jeopardize our ability to retain our providers and employees, impacting the care you’ve come to expect from us.

    There is nothing that can replace the trusted relationships you’ve built with our primary and specialty care providers, and, for these reasons, we have no choice but to advocate what’s best for our patients

    Why was this decision made?

    Blue Cross Blue Shield of IL made this decision without consulting us, and we were not given advance notice of the termination. Simply put, we’re sorry 100,000 of our patients were put in this difficult situation.  As a current patient who is covered under a Blue Cross and Blue Shield of Illinois (BCBSIL) PPO health plan, you will soon be out-of-network at all Springfield Clinic locations. This is a direct result of BCBSIL’s recent decision to terminate Springfield Clinic as an in-network provider for all of its commercial PPO plans. 

    It’s critical that you understand that we do not anticipate a resolution with BCBSIL.  

    For 82 years, we have been your physicians. We may have cared for your parents and grandparents, and our hope is to care for your children and grandchildren as well. 

    In recent years, communities like ours across the nation have seen access to quality care deteriorate. While the decision to terminate in-network coverage was not made by us, it impacts more than 100,000 patients who rely on our care. Our promise to you is to advocate for partnerships that support health care in central Illinois today and in years to come. To that end, we must reject terms that:

    • Limit access to a wide range of specialty care that would require our patients to travel to metropolitan areas to receive treatment.

    • Threaten the care we provide to 20 rural counties.

    • Restrict our ability to acquire the latest innovative treatments and technologies.

    • Jeopardize our ability to retain our providers and employees, impacting the care you’ve come to expect from us.

    There is nothing that can replace the trusted relationships you’ve built with our primary and specialty care providers, and, for these reasons, we have no choice but to advocate what’s best for our patients.

    Our trusted providers and more than 3,000 employees live and work in our communities. We value the relationships we have built with all of you. No doubt, this is a difficult journey. Still, our commitment to preserve the quality of care you have come to trust is steadfast and absolute.

    When does the termination of the Blue Cross Blue Shield PPO plans take effect?

    Effective Aug. 19, 2021, Springfield Clinic will be out-of-network for all procedures scheduled at our outpatient Ambulatory Surgery and Endoscopy Center (ASC). If you have a procedure currently scheduled for after Aug. 19, 2021, Springfield Clinic ASC staff will be contacting you to discuss your surgery options. 

    Effective Nov. 17, 2021, BCBSIL will be out-of-network for primary, specialty and urgent care and all additional medical services and lab services at all Springfield Clinic locations.

    If I have Medicare or Medicaid primary, secondary or supplemental health care plans through BCBS how I am impacted?

    For Medicaid and Medicare patients with a BCBS health plan, the details are more intricate and will vary based on your type of insurance plan.
    You are not impacted and will remain in-network with Springfield Clinic if you have one of the following plans:

    • BCBSIL Community Health Plan (Medicaid)

    • BCBSIL Medicare Medicaid Alignment Initiative (MMAI)

    • BCBS Medicare Supplements


    If you have any other BCBS Secondary or BCBS Medicare Advantage, you will need to check with BCBSIL to determine how these developments will impact your coverage.

    If you have Medicare as your primary insurance and a BCBS Federal Employee Plan as secondary, please call our Patient Advocate Call Center at 217.391.7086 to discuss whether you're affected or not. Hours are Monday-Thursday 8 a.m.- 7 p.m., Friday 8 a.m.-5 p.m. and Saturday 8 a.m.- 12 p.m.

    Can I still see my Springfield Clinic doctor if I have Blue Cross Blue Shield of IL insurance?

    Yes, but you should review the benefits and what your out-of-network costs will be for you under your Blue Cross Blue Shield of IL PPO plan. Springfield Clinic participates with fourteen commercial plans to provide the exceptional care you and your family expect and deserve from your providers at Springfield Clinic. The complete list of in-network plan choices can be viewed on our website at www.springfieldclinic.com/insurance.

    If you are currently undergoing treatment, Continuity of Care, a temporary extension of coverage, may be available for you. Continuity of Care is coordinated and administered by Blue Cross Blue Shield of IL, and we will do everything we can to support you, if you need this coverage. Please contact BCBSIL at the phone number on the back of your member card, or your employer's benefit administrator, to obtain information about how to continue in-network coverage for your current treatment. 

    What can I do if my BCBSIL insurance plan coverage is affected?

    1. If Springfield Clinic is out-of-network for your insurance plan, call us to discuss whether our self-pay options may help you manage costs. Our Patient Advocate Center is open Monday-Friday 8 a.m. to 5 p.m. Call 217.391.7086 to get your questions answered and discuss financial options.

    2. Continue to see your Springfield Clinic provider using your out-of-network benefits. Find out from your HR benefit plan administrator what your BCBSIL out-of-network benefits will be after Nov. 17, 2021*.

    3. Talk to your employer’s HR benefit plan administrator to learn more about your in-network participation options. We accept more than 13 major health care insurance plans, and you can view all available plan options at www.springfieldclinic.com/insurance

    4. Explore Continuity of Care coverage with BCBSIL if your ongoing treatment (i.e., pregnancy, cancer treatments) may qualify for this exception during this transition time.

    *Some employers have made arrangements allowing their employees currently enrolled in a BCBSIL PPO plan to continue accessing the Ambulatory Surgery and Endoscopy Center (ASC) and seeing their Springfield Clinic provider at in-network cost sharing rates after Nov. 17. Contact your HR administrator to determine if your employer has made such an arrangement.

    How is my radiology bill at a Memorial Health hospital facility impacted when read by an out-of-network provider?

    Springfield Clinic Radiologists treat patients at some Memorial Health facilities. If you have imaging (radiology) services at one of these Memorial Health facilities, you will receive a bill from Springfield Clinic for your radiology service. If Springfield Clinic is out-of-network for your health plan, your plan should only charge you at in-network patient cost-sharing levels.  Springfield Clinic will only bill you for the patient cost-sharing (ex. co-pay, deductible, co-insurance) identified by your health plan as the amount you owe for the services. Springfield Clinic will NOT balance bill you for the remainder of the claim. 

      

    If you have questions or believe there is an error in a bill from Springfield Clinic, please contact the Patient Advocacy Center (217.391.7086) to discuss your specific concern. Hours are Monday-Thursday 8 a.m.- 7 p.m., Friday 8 a.m.-5 p.m. and Saturday 8 a.m.- 12 p.m.

    I am currently in the middle of care and treatment. Can I continue to see my Springfield Clinic provider?

    BCBSIL has a continuity of care policy if your ongoing treatment (i.e., pregnancy, cancer treatments) may qualify for this exception during this transition time. You will need to contact BCBSIL at the phone number on the back of your member card to see if you will qualify for this temporary coverage extension. We will do everything we can to support you, if you need this coverage. 

    If I choose to remain with BCBSIL, what other in-network providers can I see for care?

    You can contact Blue Cross Blue Shield of IL to understand what your options are for in-network care. We will do everything we can to support your transition to an in-network provider, if you choose to do so. 

    If I want to keep seeing my Springfield Clinic provider(s), how much should I expect to spend for out-of-network costs?

    You should contact BCBSIL to review your plan benefits for out-of-network care and any related cost-sharing amounts. 

    Why are other PPOs accepted but not this one?

    Springfield Clinic maintains relationships with many insurance companies in order to provide services at an exceptional value to you. Each relationship is individual and does not affect other insurance options available to you. You can view the current list of in-network insurance options on our website, www.springfieldclinic.com/insurance.

    For 82 years, we have been your physicians. We may have cared for your parents and grandparents, and our hope is to care for your children and grandchildren as well.  In recent years, communities like ours across the nation have seen access to quality care deteriorate.

    While the decision to terminate in-network coverage was made by BCBSIL, it impacts more than 100,000 patients who rely on our care. Our promise to you is to advocate for partnerships that support health care in central Illinois today and in years to come. To that end, we must reject terms that:

    • Limit access to a wide range of specialty care that would require our patients to travel to metropolitan areas to receive treatment.

    • Threaten the care we provide to 20 rural counties.

    • Restrict our ability to acquire the latest innovative treatments and technologies.

    • Jeopardize our ability to retain our providers and employees, impacting the care you’ve come to expect from us.

    There is nothing that can replace the trusted relationships you’ve built with our primary and specialty care providers, and, for these reasons, we have no choice but to advocate what’s best for our patients.

    Who can I lodge a complaint with?

    You can reach out to BCBSIL: 

    • By calling BCBSIL at the phone number on the back of your member card 

    • By writing: 
      Blue Cross and Blue Shield of Illinois 
      300 East Randolph Street 
      Chicago, IL 60601-5099

    Ask your HR administrator if your insurance plan is fully-funded or self-funded so you know which path to take. 

    If you are part of a fully-funded plan, you can file a complaint with the Illinois Department of Insurance on their website. If you have questions about the complaint process, you can call 877.527.9431 and press 4 for health insurance questions. 

    If you are part of a self-funded plan, you can file a complaint with the U.S. Department of Labor’s Employee Benefits Security Administration on their website  or by calling 1.866.444.3272 and pressing 2 to call your regional office. 

    You can call our Patient Advocate Center at 217.391.7086 to answer your questions. Hours are Monday-Thursday 8 a.m.- 7 p.m., Friday 8 a.m.-5 p.m. and Saturday 8 a.m.- 12 p.m. Or, you can complete our feedback form

    Why did I receive a patient letter?

    You are in our records as having Blue Cross Blue Shield of IL commercial PPO insurance or BCBS primary, secondary or supplemental insurance, based on the last time you updated your insurance with us. We pulled insurance records for active patients starting Jan. 1, 2019 through the present.

    You can access the patient letters below. If you would like to update your insurance or patient information with us, please call our Patient Advocate Center 217.391.7086 and we will update our records with your current insurance information. Thank you.

    *If you have BCBSIL Medicare or Medicaid as a primary, secondary or supplementary insurance the details are more intricate and will vary based on your type of insurance plan.

    I am having trouble getting appointments with providers outside Springfield Clinic, what can I do?

    Ask your HR administrator if your insurance plan is fully-funded or self-funded so you know which path to take. There are network adequacy policies in place, but they must receive a consumer complaint to trigger an investigation. 

    If you are part of a fully-funded plan, you can file a complaint with the Illinois Department of Insurance on their website. If you have questions about the complaint process, you can call 877.527.9431 and press 4 for health insurance questions. 

    If you are part of a self-funded plan, you can file a complaint with the U.S. Department of Labor’s Employee Benefits Security Administration on their website  or by calling 1.866.444.3272 and pressing 2 to talk to your regional office. 

    My insurance claim has been processed incorrectly by Blue Cross Blue Shield, what can I do?

    Ask your HR administrator if your insurance plan is fully-funded or self-funded so you know which path to take.

    If you are part of a fully-funded plan, you can file a complaint with the Illinois Department of Insurance on their website. If you have questions about the complaint process, you can call 877.527.9431 and press 4 for health insurance questions. 

    If you are part of a self-funded plan, you can file a complaint with the U.S. Department of Labor’s Employee Benefits Security Administration on their website  or by calling 1.866.444.3272 and pressing 2 to talk to your regional office. 

    Who can I talk to at the Illinois Department of Insurance about my complaint against Blue Cross Blue Shield?

    Ask your HR administrator if your insurance plan is fully-funded or self-funded so you know which path to take. 

    If you are part of a fully-funded plan, you can file a complaint with the Illinois Department of Insurance on their website. If you have questions about the complaint process, you can call 877.527.9431 and press 4 for health insurance questions. 

    If you are part of a self-funded plan, you can file a complaint with the U.S. Department of Labor’s Employee Benefits Security Administration on their website  or by calling 1.866.444.3272 and pressing 2 to talk to your regional office. 

    Who at Springfield Clinic can I talk to about my incorrect claim or bill?

    If you need help with the claims or billing complaint process, please contact the Springfield Clinic Patient Advocate Team at 217.391.7086. Hours are Monday-Thursday 8 a.m.- 7 p.m., Friday 8 a.m.-5 p.m. and Saturday 8 a.m.- 12 p.m.

    Frequently asked questions regarding the Blue Cross and Blue Shield of IL (BCBSIL) Choice plan

    Can I still see my Springfield Clinic doctor if I choose the Blue Cross Blue Shield Choice plan?

    Yes, but you should review the benefits and what the out-of-network costs will be for you under the Blue Cross Blue Shield Choice plan. 

    What are my options if I purchased Blue Cross Blue Shield Choice on the Exchange?

    If you purchased your health care insurance through the government exchange (HealthCare.gov), then you may have the option of switching plans through Aug. 15, 2021.

    What insurance plans will Springfield Clinic be accepting as in-network for State of Illinois Employees effective July 1, 2021?

    All plans offered by the State of Illinois are in-network except the Blue Cross Blue Shield (BCBS) plans. 

    Springfield Clinic is committed to providing you with the best care at an exceptional value. The best value for State of Illinois employees for Open Enrollment 2021-2022 are the following in-network plans:

    • AETNA: HMO & OAP 

    • AETNA: Consumer Driver Health Plan (CDHP) 

    • AETNA: Quality Care Health Plan (QCHP) 

    • Health Alliance Medical Plans: HMO 

    • HealthLink: OAP 

    Contact a Payer Strategy & Contracting (formerly Managed Care) representative at 217.528.7541 ext. 43565 for further questions.

    Blue Cross Blue Shield indicates that the Choice contract ends on November 17 and Springfield Clinic says July 1. Are services provided at Springfield Clinic in-network or out-of-network from July 1 through November 17, 2021?

    Our notice indicates that Springfield Clinic is out-of-network for BCBS Choice members on July 1. BCBS, however, ultimately decides whether to process a claim at the in-network or out-of-network rate.  We would recommend that you contact BCBS to determine which network rate will apply to your visit/procedure/service.

    Am I Affected?

    If you have BCBSIL Commercial PPO* (primary or secondary)

    • As of Nov. 17, 2021, any visit with Springfield Clinic providers will be out-of-network. This applies to all 600+ of our providers and all clinic locations and services.  

    • As of Aug. 19, 2021, you will be out-of-network for services obtained at the outpatient Ambulatory Surgery and Endoscopy Center in Springfield.  
      *Some employers have made arrangements allowing their employees currently enrolled in a BCBSIL PPO plan to continue accessing the Ambulatory Surgery and Endoscopy Center (ASC) and seeing their Springfield Clinic provider at in-network rates after November 17. Contact your HR administrator to determine if your employer has made such an arrangement.

    You are not impacted and will remain in-network with Springfield Clinic if you have one of the following plans:

    • Blue Cross Community Health Plan (Medicaid)

    • Blue Cross Community Medicare Medicaid Alignment Initiative (MMAI)

    • BCBS HMO Illinois UnityPoint 457 (Peoria Specialty Providers Only)

    • BCBS Medicare Supplements

    *If you have BCBSIL Medicare or Medicaid as a primary, secondary or supplementary insurance the details are more intricate and will vary based on your type of insurance plan. If you have Medicare as your primary insurance and a BCBS Federal Employee Plan as secondary, please call our Patient Advocate Call Center to discuss whether you're affected or not.

    If you have BCBSIL Choice (primary or secondary)

    • As of July 1, 2021, any visit with Springfield Clinic providers will be out-of-network. 
      While Blue Cross Blue Shield Choice Members are out-of-network July 1, Blue Cross Blue Shield ultimately decides whether to process a claim at the in-network or out-of-network rate. We recommend that patients call the phone number on the back of their member cards to determine which network rate will apply to the visit/procedure/service. If you have any other BCBS Secondary or BCBS Medicare Advantage you will need to check with BCBS.