Losers are clear in health-care battle

Even under the best of circumstances, patients often find it confusing to navigate the maze of rules, procedures and paperwork that inevitably accompany health care and health insurance.

But when a health insurer and a health care provider drop the gloves and duke it out - as Blue Cross and Blue Shield of Illinois and Condell Medical Center are doing - then confusion can quickly escalate to chaos for hapless patients who get caught in the middle.

The tenuous relationship between Blue Cross and Libertyville-based Condell all but collapsed this week with a Cook County judge's ruling that Condell may terminate its contract with Blue Cross before year's end because Blue Cross already has broken the contract by refusing to reimburse the hospital for services rendered to patients covered by Blue Cross.

Serious trouble erupted in June, when Blue Cross stopped making reimbursement payments to the hospital. Blue Cross officials said they took that action in response to Condell seeking higher reimbursement rates that it said were needed to cover its costs of providing service. Blue Cross executives complained Condell was seeking higher reimbursement rates than stipulated by contract. Tuesday's ruling came down squarely on Condell's side.

But what a mess for tens of thousands of Lake County residents. The judge's ruling means that Condell may now bill Blue Cross PPO patients directly. Patients, in turn, will have to seek reimbursement from Blue Cross. It also means, after Oct. 31, that those patients, if they want to continue receiving care from Condell, will have to pay out-of-network rates, which typically range far higher than in-network costs.

Blue Cross is trying to reassure its clientele by reminding people that they will not be billed directly if they seek treatment with other physicians within their network -- just not those who work exclusively out of Condell. Undoubtedly, some people will switch doctors rather than try to navigate the daunting world of direct billing. But what about patients who have developed a long-standing and trusting relationship with a Condell provider? Who in the middle of ongoing treatment for a serious or complicated condition wants to switch doctors?

Though the judge sided strongly with Condell in this week's ruling, months may pass before the longer-term impact on either Condell or Blue Cross can be determined.

It won't take nearly that long to identify the real losers: all of the affected patients.

They will be inconvenienced, frustrated and in some cases will end up paying more for health care. They are the ones who in other cases will feel compelled to work with new doctors.

Regardless of whether Blue Cross or Condell has the stronger argument, all of these patients, once they have a choice again, may be disinclined to work with either.