Deal struck between Carle and Blue Cross and Blue Shield of Illinois

URBANA — If your doctor is at Carle, you might have a new health insurance choice soon: Blue Cross and Blue Shield of Illinois.

Carle and the Blues have struck a deal that will bring the majority of Carle doctors — excluding primary care providers at some Carle locations — into the insurer's provider network, The News-Gazette has learned.

Blue Cross and Blue Shield has already had a contract with Carle Foundation Hospital, as well as with competing local physician practice Christie Clinic. Blue Cross and Blue Shield has also been an accepted health plan for the Hoopeston Regional Health System, including its hospital and area clinics, that was acquired by Carle last year.

But while Carle's Urbana hospital has had a relationship with the insurer, that relationship didn't extend to the doctors under the former Carle Clinic, even after it was acquired by the hospital in 2010.

Blue Cross and Blue Shield's new contract with Carle Physician Group, effective June 1, was prompted by member/patient dissatisfaction, according to Blue Cross and Blue Shield of Illinois spokeswoman Mary Ann Schultz.

"Patients were confused when they would go into the hospital and be treated by a provider who was not in the network and receive a bill for out-of-network services," she said in an email. "Now they have the opportunity to see additional physicians in our PPO network and seek services in-network and pay lower out-of-pocket costs."

Carle Chief Financial Officer Dennis Hesch said a lot of time and effort were being spent on insurance issues resulting from Blue Cross and Blue Shield patients coming into Carle's trauma center and neonatal intensive care unit center for care, and Carle wanted to take patients out of the middle of those issues.

"We are pleased with this new agreement and believe it will help our many patients who rely on Carle for specialty care and hospital services, especially as a Level I Trauma Center and in our NICU," Hesch said.

The contract excludes Carle primary care providers — those in family medicine, pediatrics, internal medicine and convenient care — at Champaign, Urbana, Mahomet and Danville, Carle spokeswoman Jennifer Hendricks said.

That's because Carle doesn't have the capacity to add many new patients at those locations and wants to be sure it has enough provider access for its current patients, Hesch said.

"We want to make sure we provide access to our current patients while minimizing issues for people coming into the Carle system," he said.

Hendricks said as Carle adds physicians, it will consider adding more primary care providers in the Blue Cross and Blue Shield network.

The Blue Cross and Blue Shield PPO network will include Carle primary care doctors in Mattoon, Monticello, Rantoul, Tuscola, Hoopeston, Cissna Park, Rossville and Watseka, according to Carle and the insurer.

All Carle specialists will be in-network for Blue Cross and Blue Shield, Hesch said.

He also said the potential impact of the new Blue Cross and Blue Shield contract on Health Alliance Medical Plans, owned by Carle, wasn't considered.

"The emphasis is really on member and patient satisfaction," he said.

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1conservativemom wrote on May 07, 2013 at 10:05 pm

Well it's about damn time.

Sandy wrote on May 07, 2013 at 10:05 pm

Excluding primary care providers from this contract is the fire wall that keeps Health Alliance as a choice despite the Governor's desire to drop it. I want to keep Health Alliance, but it's unbelievable that they didn't consider the ramifications when making this decision.

It's also hard to believe that there is no link between the decision to extend Carle's tax exempt status and the huge amount of money the state owes them (and is not paying). 

 

 

GeneralLeePeeved wrote on May 08, 2013 at 2:05 pm

OK, I know I'm cynical, but all this move does is help Quinn and the others who wanted to let BCBS take over the whole state achieve their goal (I sure hope they enjoy their payoff!).  It's probably too late for them to implement this for FY2014 (which starts July 1), but us University employees shouldn't count on being able to pick Health Alliance beyond this election period.

honesty wrote on May 08, 2013 at 9:05 pm

so they make a contract to reduce confusion? Really? so none of the primary care doctors are in the bcbs network wow that really helps clarify things.