Illinois looks to get tougher on payers following BCBS, Springfield Clinic impasse

Following a monthslong contract impasse between Blue Cross Blue Shield of Illinois and Springfield Clinic, Illinois lawmakers are looking to enact harsher penalties for payers that violate the state's insurance code.

State Rep. Sue Scherer filed a bill March 23 that would impose specific fines and penalties for payers that violate the Network Adequacy and Transparency Act. The Illinois Department of Insurance would be able to publicly say when a coverage plan is under a market conduct exam. It would also allow for the public release of certain details under the Freedom of Information Act.

On March 23, Gov. J.B. Pritzker called on BCBS and Springfield Clinic to reach a deal that would reconnect about 100,000 patients in central Illinois with their preferred physicians, according to WCIA.

Members of the Pritzker administration have recently met privately with representatives from BCBS and Springfield Clinic to request that they overcome the contract dispute.

On March 21, Illinois fined BCBS' parent company, Health Care Service Corp., $339,000 for failing to properly file updated network adequacy documents after the termination of its contract with Springfield Clinic in November.

BCBS has claimed Springfield Clinic is seeking a 75 percent raise in reimbursement levels for its physicians, according to WCIA.

Springfield Clinic says all other payers in the region pay them the same or similar amounts for services.

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