Springfield Clinic BCBS Agreement and What It Means

Springfield Clinic has partnered with Blue Cross Blue Shield (BCBS) to provide patients with a wide range of insurance options.

This agreement allows patients to receive care at Springfield Clinic while still maintaining their BCBS insurance coverage.

The partnership means that patients can access a variety of medical services, including primary care, specialty care, and hospital services.

The agreement also means that patients will only need to pay their standard BCBS copays and coinsurance for services received at Springfield Clinic.

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Springfield Clinic is at the center of a dispute with Blue Cross Blue Shield of Illinois over network adequacy.

The clinic has been out of network with Blue Cross for over a year and a half, and thousands of patients are still unable to see their doctors and specialists.

Springfield Clinic leaders are disappointed that Blue Cross wasn't transparent about ongoing problems with network adequacy.

The Blue Cross directory continues to show 98 clinic providers as in-network that are actually out-of-network.

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There are at least five specialties where Blue Cross fails to meet network adequacy standards and four specialties that are close to violating the state's standards.

Currently, there are no providers available for rheumatology, radiation oncology, or allergy patients in the Blue Cross network.

The state requires insurance companies to have 20 OB-GYNs in network, but BCBSIL only has nine available for patients.

There is only one ophthalmologist in the Blue Cross network, which falls short of the state's requirement of five providers.

Springfield Clinic leaders question whether Blue Cross intentionally or unintentionally left providers in the directory to mislead patients.

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Blue Cross Blue Shield of Illinois and Springfield Clinic have reached an agreement, ending a years-long rift between the health insurance provider and medical group. This agreement will allow patients/members to return to in-network status at Springfield Clinic beginning on Jan. 1, 2024.

The agreement is for most BCBS plans, except Blue Choice. If you have questions about plans and in-network status, please contact Springfield Clinic's Patient Advocate Center at 217.391.7086.

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Some BCBS plans, like the one offered to State of Illinois Employees, have Tier 2 benefits that allow patients to utilize the PPO network. This can be identified by "BCO" on the front of the card, as well as information concerning Tiered Plans on the back of the card.

Here's a breakdown of the in-network and out-of-network status:

Patients wanting to set up in-network care can call Springfield Clinic after Dec. 26 to confirm their status.

The transparency issue between Springfield Clinic and Blue Cross Blue Shield of Illinois is a major concern. Thousands of people can't see their doctors and specialists due to ongoing problems with network adequacy.

Springfield Clinic leaders are disappointed that Blue Cross wasn't transparent about these issues. They claim the insurance company is misleading patients by listing 98 clinic providers as in-network when they're actually out-of-network.

This problem has been going on for over a year and a half, with Springfield Clinic being kicked out of network. The clinic's vice president, Zach Kerker, says this is not the issue, but rather Blue Cross's misrepresentation of their network.

There are at least five specialties where Blue Cross fails to meet network adequacy standards, including no providers available for rheumatology, radiation oncology, or allergy patients.

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