SPRINGFIELD, Ill. (WAND) — Blue Cross Blue Shield of Illinois continues to advertise and sell health plans that fail to meet network adequacy standards in Central Illinois. Local lawmakers are furious that thousands of people still can’t see their Springfield Clinic doctors and specialists.

Eighteen months have gone by and patients are still facing the same issue. The Blue Cross directory continues to show 98 Springfield Clinic providers as in-network when they are not.

“People are scared. They shouldn’t have to file a complaint with the Department of Insurance to get insurance that they pay for,” said Rep. Sue Scherer (D-Decatur). “That’s ludicrous. They should get the insurance they pay for.”

Blue Cross Blue Shield’s parent company has already paid $1 million in fines to the Illinois Department of Insurance for failing to fix the network adequacy issues. Local lawmakers on both sides of the aisle know the fines are only a drop in the bucket for the insurance giant, and they want stronger penalties put in place.

“I don’t want to see my citizens in the 54th district or anywhere else in this state get taken advantage of or ripped off by an insurance company,” said Sen. Steve McClure (R-Springfield). “It’s up to us to stick up for our constituents and that’s exactly what we’re trying to do.”

McClure and Sen. Doris Turner (D-Springfield) have joined Scherer and Rep. Mike Coffey (R-Springfield) in writing letters to the department demanding swift action. McClure told WAND News that he plans to meet with leaders from the department and Blue Cross Blue Shield soon.

“I would just encourage them to get on top of these concerns that my constituents have and fully investigate them, and then we can go from there to try and correct some of these things,” McClure said. “But until it’s fully investigated and there are penalties that have some teeth, nothing is going to change.”

Meanwhile, Scherer has filed a bill to create transparency and harsher penalties for any insurance companies violating network adequacy standards. Her plan could require insurance groups to report any changes to their approved network plans within 15 days. Companies would face a $1,000 each day they fail to submit updated network plans.

House Bill 4126 also states that the agency’s director may prohibit network plans from being used or renewed within a county until the department determines the insurance network is adequate again. Insurers failing to update their network plan directories could face civil penalties of $5,000 per month. Scherer also believes insurance companies should audit their print and online directories for accuracy and make necessary corrections at least once every 90 days.

The legislation could give the department the authority to file emergency rules to implement the federal standards for provider ratios, travel time and distance, and appointment wait times if they are more stringent than the state’s standards.

“If the problem gets big enough, the people get loud enough and democracy works,” Scherer stressed.

She explained the Pritzker administration and Speaker Emanuel “Chris” Welch’s Chief of Staff agree that the ghost networks must be stopped as soon as possible. Scherer would like to see her bill moved during veto session this fall rather than shelving the plan for the 2024 spring session.

“It is time to use statutory and regulatory authority to bring them into compliance, or temporarily order them to stop selling plans to consumers until they come into compliance,” Scherer said.

Blue Cross Blue Shield’s parent company has already paid $1 million in fines to the Illinois Department of Insurance for failing to fix the network adequacy issues.

The IDOI Communications Director stated Tuesday night that the department diligently enforces insurance laws to protect Illinois consumers’ rights as set forth by the General Assembly. Caron Brookens said the agency has worked closely with state lawmakers to address their concerns and support proposed legislation that increase consumer protections and the department’s regulatory authority regarding health insurance companies offering fully-insured plans that must comply with Illinois network adequacy requirements.

“The department will continue to hold insurers accountable under the law to help improve equity and access to health insurance coverage and is committed to ensuring that Blue Cross Blue Shield of Illinois complies with the Director’s order from the most recent market conduct exam,” Brookens stated.

If you or anyone you know need help accessing care and navigating insurance provider networks click here. You can also file complaints against insurance companies by submitting information here.

Copyright 2023. WAND TV. All rights reserved.