Illinois IDOI – $339,000 Fine for Blue Cross Blue Shield

Governor Pritzker Announces $339,000 Fine for Blue Cross Blue Shield for Failing to Submit Required Information After Terminating Springfield Clinic Contract

CHICAGO, IL (STL.News) For the first time ever, the Illinois Department of Insurance (IDOI) announced today fines totaling $339,000 for Health Care Service Corporation (HCSC), the parent company of Blue Cross Blue Shield of Illinois, for violating the material change notice requirement in the state’s Network Adequacy and Transparency Act.

Network adequacy filings are an important tool to help ensure that consumers have access to a network of providers that meets proper time and distance standards.  This is critical to ensuring that patients have access to care that they need.

The Department found that the company did not properly file updated network adequacy filings following the termination of its contract with Springfield Clinic which serves approximately 100,000 consumers in Central Illinois. After months of delay, the Department finally received BCBS’s final filing for its network adequacy review on Thursday. The Department determined that the filings were 244 days late and 95 days late, accumulating a total fine of $339,000. Late fees are $1,000 per day.

“Insurance companies must be able to show that they have adequate provider networks, so that Illinois consumers have access to the medical care and providers that they pay for,” said Governor JB Pritzker.  “This fine should serve as notice that we will require insurers to maintain adequate provider networks and uphold all consumer protections under the law.”

Although the Department reviews every plan’s network for adequacy when the plan is filed, the law recognizes that a plan’s network may change mid-plan year.  In anticipation of these potential changes, there is a provision that if there is a “material change” in the network, the company must submit updated network adequacy filings to demonstrate that the change has not rendered the network inadequate.  Under state law, insurers are required to report to the Director any material change to an approved network plan within 15 days after the change occurs.

“This is the first time the Department has issued a fine for the material change filing requirement in the Network Adequacy Transparency Act,” said IDOI Director Dana Popish Severinghaus.  “We’re disappointed that the company continues to evade acknowledging this material change.  Under Illinois law, the removal of a major health system, like Springfield Clinic, is a material change that could render a network, or parts of a network, inadequate.  We are committed to exercising the Department’s full authority to protect consumers from being harmed in a corporate contract dispute.”

Blue Cross Blue Shield must pay the fine immediately, and the company has 10 days to contest the fine.  The Department will continue its review of the network adequacy filing for compliance with applicable state and federal laws.

The Notice of Apparent Liability for late filing of Network Adequacy can be found here.