Blue Cross, Condell to part ways

Thousands of Condell Medical Center patients are getting caught in the crossfire in an ongoing feud between the Libertyville hospital and one of the state's largest insurance companies.

Beginning Sept. 30, Condell will no longer accept Blue Cross Blue Shield of Illinois PPO.

The company's HMO Illinois and Blue Advantage HMO customers aren't faring much better. That insurance will be accepted by the hospital only through the end of the year.

"This will have a significant effect on our patients as well as Condell," said Jodi Levine, vice president of business development for the hospital.

What this means is patients scheduled for cancer treatments, surgeries or births after the contracts expire will have to find a new doctor and hospital, or hope that their physician practices at another hospital still accepting Blue Cross Blue Shield.

The two groups have been involved in bitter contract negotiations since the end of 2006.

One of the major hangups has been a request by Condell to increase its reimbursement from the insurance company by 30 percent, an amount viewed as unreasonable by Blue Cross Blue Shield.

Levine said the last straw came when Blue Cross Blue Shield stopped making payments to the hospital in June, costing Condell millions and forcing them to terminate its relationship.

Tony Rau, Blue Cross Blue Shield spokesman, said Condell has been paid for its services and he was under the impression the PPO contract, like the HMO agreement, would remain through the end of the year.

When asked how PPO and HMO patients would be affected by the terminated contracts, Rau did not have an answer.

"We're still talking with Condell and don't have much more to add at this point," he said via e-mail. "We will, of course, keep our members updated."

Levine estimated Blue Cross PPO and HMO patients make up about 20 percent of the hospital's patients. As far as the number of patients Condell has, Levine estimated tens of thousands.

While the hospital will take a financial hit by losing Blue Cross Blue Shield patients, Levine said Condell has been losing money for years because of the relationship with the insurance provider.

"We are very, very disappointed that we have been forced into this position," Levine said. "We are certainly open to getting the situation resolved, but now it is in Blue Cross's hands."