Decision by Blue Cross and Blue Shield Impacts Patients and Employers Throughout the State
OSF HealthCare is still part of Blue Cross and Blue Shield of Illinois PPO plans through December 31, 2017. At the beginning of this month, while still engaged in active negotiations, Blue Cross and Blue Shield of Illinois announced plans to drop three hospitals from its PPO network: OSF HealthCare Saint Francis Medical Center (Peoria); OSF HealthCare Saint Anthony Medical Center (Rockford); and OSF HealthCare St. Mary Medical Center (Galesburg). The termination was issued unilaterally by Blue Cross and Blue Shield of Illinois, and is set to occur January 1, 2018.
By removing these hospitals from its network, BCBSIL eliminates important referral centers and reduces patient access to advanced, critical services within our system. Without patient access to our terminated hospitals, OSF HealthCare was forced to terminate most of its remaining Blue Cross and Blue Shield hospital agreements. As of the first of the year, Illinoisans with BCBS PPO health insurance plans will only be able to access care at hospitals owned by OSF HealthCare using out-of-network benefits. The one exception will be OSF HealthCare Saint Anthony’s Health Center in Alton, which will remain in the BCBSIL PPO network.
It is our hope that Blue Cross and Blue Shield will realize the value of having OSF HealthCare hospitals in its network for its members. OSF is open to continuing discussions with Blue Cross and Blue Shield to avoid a disruption to patients.
“OSF HealthCare is an accountable care organization committed to population health, which is achieved through ensuring patients have access to the full resources of its integrated health care delivery system,” said Randy Billings, OSF HealthCare senior vice president of population health. “By eliminating three of our hospitals from its network, Blue Cross and Blue Shield eliminates important referral centers and patient access to nearby specialty care - including our children’s hospital.”
OSF HealthCare Children’s Hospital of Illinois was recently ranked in the top 50 by U.S. News & World Report for pediatric urology and neonatology. Blue Cross and Blue Shield has several quality programs recognizing hospitals and their performance to help members determine the best place for care, including Blue Distinction Specialty Care and Blue Distinction Total Care. OSF HealthCare hospitals are consistently high-performing in most of these programs. For a detailed listing, go to the Blue Cross and Blue Shield website.
Patients with Blue Cross and Blue Shield PPO plans living in rural communities served by OSF HealthCare hospitals will only be able to seek care in their own town, or access nearby tertiary and quaternary care in Peoria and Rockford, using out-of-network benefits.
“We are deeply disappointed and concerned by recent actions taken by Blue Cross and Blue Shield of Illinois,” said Billings. “It is our hope that Blue Cross and Blue Shield will realize the value of having OSF HealthCare hospitals in its network for its members. OSF is open to continuing discussions with Blue Cross and Blue Shield to avoid a disruption to patients.”
BCBSIL members can contact their employer regarding other insurance company choices or may direct concerns or benefit plan inquiries to the Blue Cross and Blue Shield Customer Service phone number at (800) 538-8833.
In the meantime, OSF HealthCare encourages employers and community members who rely on us for their health care needs to choose an insurance product that ensures access to the full breadth of services that OSF HealthCare provides. OSF HealthCare participates in most national and local managed care plans. A complete list can be found at osfhealthcare.org.
The following are additional quotes and downloadable interview clips from Randy Billings, OSF HealthCare Senior Vice President of Population Health.
Randy Billings, OSF Health Care, Senior Vice President of Population Health on what happened October 2, 2017:
“First of all Blue Cross terminated OSF HealthCare – three of our hospitals - October second. They did it in the midst of negotiations. We were meeting with them as recently as the week before, even the Friday before. With no advance notice they terminated with OSF Saint Francis in Peoria, OSF St. Mary in Galesburg, and OSF Saint Anthony in Rockford.”
Randy Billings, OSF Health Care Senior Vice President of Population Health on the ripple effect of the BCBS termination:
“Because they terminated our facilities, it impacts the coordination of care, continuity of care, the care across the entire system that OSF prefers to give to our patients. It’s our mission to serve the neediest of the patients and for those who are the sickest. Without those hospitals that Blue Cross terminated, we felt we were forced to terminate other hospitals that can’t now refer to those facilities. So the other seven hospitals in the OSF system were terminated because we can’t provide care across the entire continuum."
Randy Billings, OSF Health Care, Senior Vice President of Population Health on his reaction to the BCBS termination decision:
“Surprised. Shocked. It was out of the blue. They had not given us any notice of the termination. We had been talking and in discussions the week before even. We had multiple meetings that week, and it was frankly a shock. So we’re disappointed that Blue Cross has done this and hope that they will see fit to include OSF facilities in their network as of January."
Randy Billings, OSF Health Care Senior Vice President of Population Health on patient loyalty and appreciation:
"We understand your need and desire to have your services at OSF HealthCare. We appreciate that, and thank you for seeking care at our hospitals."
Randy Billings, OSF Health Care Senior Vice President of Population Health on recommended next steps for patients:
“Blue Cross did put us, we feel, in a difficult situation to have to terminate the remainder of the hospitals. So to those who are going to be out of network as of January 1, we would encourage you to see what your out of network benefits might contain, in order to continue going to an OSF facility. We encourage you to look to your employers for other options that the OSF facilities participate in, and will participate in as of January 1, and our website has a list of every one of those other options that are available to most employers that are contracted with most of the major payers products in Illinois."
Randy Billings, OSF Health Care Senior Vice President of Population Health on where to find more information:
“OSF participates in virtually all of the other major payers in the market. We have a full listing on our website, and you can go and look at those by hospital or by plan to determine if your insurance company is listed, or whether your employer offers those plans. Certainly we hope that Blue Cross will see the need for having the OSF hospitals in their network and will come to an agreement for January 1 as well.”
Randy Billings, OSF Health Care Senior Vice President of Population Health on what is still covered:
"The physician group was not terminated by Blue Cross. The service lines: Neurosurgery, Cardiovascular Service Line and Children’s Service Line, the physician portion. We are not terminated by Blue Cross. Obviously for those members who need to go to a hospital, either outpatient or inpatient services, they will be effective January 1. If you have a service that you feel you want to have completed at OSF, we are willing to and happy to have you come. You need to check your benefits, and OSF will do all we can to accommodate those who are in the course of care.”
Randy Billings, OSF Health Care Senior Vice President of Population Health on trauma patients still being covered:
"The insurance companies are required to include trauma and emergency services in their benefit plans, so those will not be out of network. Patients will still be seen. OSF will see all those who come to our emergency departments, regardless of their payer, regardless of their illness, regardless of their desire to be here or not, we will see those patients, and so they will still be seen.”
Randy Billings, OSF Health Care Senior Vice President of Population Health on accommodating patients:
“We will accommodate any others in the course of treatment, or who want to still see us at our facilities the best that we can in order to continue their care at an OSF facility, or at another facility that is in their network."
Randy Billings, OSF Health Care Senior Vice President of Population Health on the OSF HealthCare Mission:
"OSF does not check your ID card when you come through our ER department or trauma center, and determine whether we can see you or not. We see all patients, and are especially concerned in our mission to serve the most disadvantaged and under-privileged and the sickest of the sick. We want to make sure that we can provide care and we will continue to do so.”
OSF HealthCare is an integrated health system owned and operated by The Sisters of the Third Order of St. Francis, headquartered in Peoria, Illinois. OSF HealthCare employs nearly 19,000 Mission Partners in 115 locations, including 11 hospitals - 7 acute care, 4 critical access - and two colleges of nursing throughout Illinois and Michigan. Its physician network employs nearly 1,200 primary care, specialist physicians, and advanced practice providers. OSF HealthCare operates an extensive network of home health services; owns OSF Saint Francis, Inc., comprised of healthcare-related businesses; and OSF Healthcare Foundation, the philanthropic arm for the organization. OSF Innovation, ranked among the top 10 innovation centers in the country, is located in Jump Trading Simulation & Education Center. Launched in 2016, OSF Innovation is a multidisciplinary innovation center focused on internal and external innovation of the largest health care challenges. More at www.osfhealthcare.org.