Updated Sept. 9, 2021
Our members are at the core of everything we do. Blue Cross and Blue Shield of Illinois (BCBSIL) is committed to working with health care providers across the state to advance access to quality, value-based health care.
Our focus is on value for our members and employer groups — and that means facilitating access to quality care at a competitive price.
Standing with our members
We do everything in our power to stand with our members in sickness and in health. When we look at the health care landscape in Illinois, we see that central Illinois has some of the highest prices for health care in the state. In fact, the cost of living in Springfield is 5% below the national average while Chicago is 23% above. Yet, health care in Springfield is 16% more expensive than in Chicago!
This is not sustainable for our members and local businesses. Any demand for artificial, above market reimbursement rates in the middle of a global pandemic drive up the cost of care for everyone including our members and employer groups.
We value the care Springfield Clinic’s doctors and health care providers give our members. But our members and employer groups can’t sustain the financial burden of a Springfield marketplace where health care is 16% more expensive than in Chicago. We hope that Springfield Clinic embraces movement toward increased quality and value-based care and stays in-network. We will do all we can to protect our member’s health care dollars, including giving them access to other, in-network, quality providers at fair prices.
- We’ve had a relationship with Springfield Clinic for nearly 30 years.
- Earlier this summer, Springfield Clinic sent us a notice that they were leaving our Blue Choice network in 30 days. This improper notice was not consistent with the terms of our participation agreement, which requires a longer notification period to allow for the safe transition of our members’ care.
- The notice arrived during the 2021 open enrollment period for one of the largest employers in Springfield, impacting many of our members.
- To add confusion, Springfield Clinic sent communications directly to our members and local customers with the improper termination date.
- We then sent our members letters with the correct termination date of Nov. 17, 2021.
We are still doing our best to work with Springfield Clinic to keep their doctors and health care professionals in-network while also managing access, quality and costs for our members and customers. We believe in paying for value and want to ground our arrangements with providers in improved health outcomes and quality care. We hope they will choose to stay in our networks.
We are advocates for our members and employer groups. As we diligently work with Springfield Clinic, we need to find a solution that provides access to quality health care without sacrificing the value of our members’ monthly premium dollars and unnecessarily increasing out-of-pocket costs.
We stand with our members and employer groups and remain focused on what we have been committed to for over 85 years — access to quality, cost-effective health care for Illinoisans.
You need to know
- Springfield Clinic’s participation agreement for PPO and Blue Choice networks will end on Nov. 17, 2021, unless a new arrangement can be made.
- Springfield Clinic discontinued its relationship with PHAI and therefore left our HMO networks July 1, 2021, and will leave our Medicare Advantage HMO network on Oct. 1, 2021.
- Medicaid and MMAI are not part of this negotiation and are not impacted.
- In addition, Springfield Clinic’s ambulatory surgery center is out of network for all our members as of Aug. 19, 2021.
- We have been reaching out to our members who were receiving care or scheduled to receive care at Springfield Ambulatory Surgery Center to safely transfer their care to other in-network facilities.
- We will continue to be available to help our members find in-network care in the areas that are served by the Springfield Clinic Ambulatory Surgery Center.
We remain committed to working with Springfield Clinic to find a solution that will ensure our members get the right care, at the right place, for the right price. However, regardless of the outcome of this negotiation, our central Illinois members will continue to have access to quality, affordable health care through our robust provider networks.
If we are not able to reach an agreement that provides the kind of quality and value our members deserve, we will do everything we can to help members move their care to quality, cost-effective, in-network doctors and clinics.
- Moving to in-network providers helps members keep their out-of-pocket costs low. It also helps them to continue building in-network accruals toward their deductible.
- BCBSIL has other in-network providers in the Springfield area who demonstrate a commitment to quality and value.
- Some members being treated for certain conditions may be covered by what is known as "continuity of care." This means they may still be able to use Springfield Clinic at the in-network benefit level under their current plan for a period of time, even if Springfield Clinic leaves our networks.
Members can call the number on their member ID card with questions about their BCBSIL coverage or continuity of care. We’re here to help.
If you have any questions about what Springfield Clinic is saying or doing on this topic, please call Springfield Clinic at 217.391.7086.
Continued community support
We understand the impact this has on our community because we are part of the community. Central Illinois is home to more than 3600 employees, which is why we stand with our Springfield workforce, members and employer groups and remain focused on what we have been committed to for over 85 years — access to quality, cost-effective health care for Illinoisans.
For decades, BCBSIL has been a committed partner to improving the health and wellness of the communities it serves. We’ve worked to improve critical social determinants of health like access to care, education, food, housing and safe environments. We have long standing partnerships with several community-based organizations and support the valuable work that contributes to a healthier central Illinois.
BCBSIL is committed to helping improve health outcomes of all central Illinoisans by supporting organizations such as the Central Illinois Food Bank, which in the last 12 months increased their distribution of fresh products by nearly 20%, providing close to 8 million pounds of food.
We also focus on the needs of the Springfield community through organizations like Contact Ministries, that provide shelter to women and women with children up to age 17 — giving these women and families a safe and stable environment where their basic needs can be met.
In the last decade alone, we have contributed over $7 million to organizations in Central Illinois that improve housing, alleviate hunger, increase access to care, improve behavioral health and most recently provide COVID-19 health education and vaccine access.
In 2020 and 2021, BCBSIL launched the COVID-19 Community Collaboration Fund, a grant program aimed at supporting community-based organizations. Of those organizations, 22 serve to help expand crucial assistance for those in need in Central Illinois counties.
Access to Care
- BHicks Childcare and Community Outreach
- Children’s Research Triangle
- Developmental Services Center (DSC)
- Family Guidance Centers, Inc.
- Illinois Association of Free and Charitable Clinics
- Planned Parenthood of Illinois
- The Hope School
- Young Men’s Christian Association of Springfield
- Heritage Behavioral Health Center, Inc.
- The Salvation Army (Heartland Division)
Access to Food
- Central Illinois Foodbank
- Midwest Food Bank
- Feeding Our Kids
- Danville Family YMCA
- Senior Services of Central
- Table of Life Ministries
- The Outlet
- VNA Community Services Knox County
Access to Shelter
- C.E.F.S. Economic Opportunity Corporation
- Midwest Youth Services
- Contact Ministries
- COVID-19 Health Education/Vaccine Access
- Faith Coalition for the Common Good, serving Sangamon County, providing COVID-19 health education/vaccine access
- Springfield Urban League Inc.
For years we have addressed food insecurity and sponsored local events such as farmers markets and food distributions. We’ve awarded grants to organizations that remove barriers to adequate nutrition.
Our employees have dedicated thousands of volunteer hours supporting local causes that are important to them.
- Ronald McDonald House of Central Illinois, 2021 Cycle of Hope. Employees participated to raise funds to provide a place for families of sick children to stay while receiving medical care.
- BCBSIL employees also volunteered to support organizations like Friend In Deed, by distributing meals, clothing, and toys to families during the holiday season.
- Employees also contributed to the Illinois Stewardship Alliance, an organization working to build a strong food and healthcare system in central Illinois.
- Employees helped support the YMCA by contributing to local chapters that serve Springfield by providing programs that promote personal growth as well as the balanced development of spirit, mind and body for all.
Q: Is Springfield Clinic in-network if I have a Blue Choice or PPO plan?
A: Yes. Springfield Clinic is currently in-network and will remain in-network until Nov. 17, 2021, for the BCBSIL PPO and Blue Choice networks. Blue Choice plans include Blue Choice Options, Blue Choice Select and Blue Choice Preferred. Springfield Clinic also remains in-network for the BCBSIL Blue Choice Tier 1 benefits for the State of Illinois Open Access Plan members until Nov. 17, 2021. After Nov. 17, 2021 Springfield Clinic providers will be out-of-network, unless an agreement can be reached which focuses on quality and value-based care.
Q: Is Springfield Clinic in-network if I have an HMO plan?
A: BCBSIL does not directly contract with Springfield Clinic for HMO plans. Springfield Clinic instead contracts with PHAI for their participation in the networks. Our understanding is that Springfield Clinic terminated its participation with PHAI on June 30, 2021. However, PHAI will continue to remain in-network and will actively participate in BCBSIL’s Blue Advantage and HMOI plans.
Q: Is Springfield Clinic in-network if I have a Blue Cross Medicare or Medicaid plan?
A: Yes, Springfield Clinic is in-network for Blue Cross and Blue Shield of Illinois Medicare, Medicaid, and MMAI plans.
Q: Why did Springfield Clinic first say it was going out-of-network for some BCBSIL plans on July 1, 2021?
A: We are unsure. This is incorrect information caused confusion for our members and group customers. Springfield Clinic’s participation agreement for the PPO and Blue Choice networks will terminate on Nov. 17, 2021, consistent with the details of our agreement, unless a new arrangement can be made. At this time, there is no need for BCBSIL members to take any action. BCBSIL will notify members if we are unable to reach a new agreement with Springfield Clinic.
Q: How is BCBSIL working to slow rising costs while increasing access to value-based care?
A: We’re boldly collaborating with business owners and health care providers to drive value by slowing rising costs while increasing access to value-based health care. We believe in paying fair prices for quality care that produces better health outcomes. Quality primary and behavioral health care includes:
- A focus on preventing and managing chronic conditions
- Leaning into health equity for all
- Supporting improvements to social determinants of health (access to good jobs, stable housing, nutritious food, and education)
Deep transformation requires all of us working together and rowing in the same direction to make big change.
Q: Is there hope for a resolution? In a recent communication to patients, Springfield Clinic stated that they do not anticipate a resolution.
A: We are absolutely hopeful that we can reach an agreement with Springfield Clinic. It’s concerning that Springfield Clinic is actively communicating to the marketplace that it will definitely be out-of-network on November 17. We desire to continue our relationship with Springfield Clinic — with the right incentives and value-based care as part of our agreement.
Q: Springfield Clinic is stating that BCBSIL is responsible for the decision to terminate the contract.
A: In contract negotiations, there are always two sides to every story. While we certainly have a desire to defend against misinformation and improper pretense, that is not what serves our membership best. Our focus is on finding solutions with Springfield Clinic and its physicians with hope that they do not choose to go out-of-network on Nov. 17. Rest assured that BCBSIL stands with its members and employer groups and is focused on what we have been committed to for over 85 years — access to quality, cost-effective coverage and health care for Illinoisans.
Q: For the State of Illinois Open Access Plan (OAP), what is changing?
A: For now, nothing is changing:
- BCBSIL Blue Choice Network providers are in Tier 1
- PPO is Tier 2
- OON is Tier 3
After Nov. 17, 2021, Springfield Clinic will be out-of-network for all Open Access Plan options, unless an agreement can be reached which focuses on value and quality.
About Blue Cross and Blue Shield of Illinois
Blue Cross and Blue Shield of Illinois (BCBSIL) is committed to expanding access to quality, cost-effective health care to as many people as possible in Illinois. BCBSIL is dedicated to innovation and exploring, nurturing and activating future possibilities to make the health care system work better for our members and our communities. BCBSIL is a division of Health Care Service Corporation, a Mutual Legal Reserve Company and an Independent Licensee of the Blue Cross and Blue Shield Association.