Blue Cross working to ease transition
As many readers know, Condell Medical Center in Libertyville terminated its contractual relationships with Blue Cross and Blue Shield of Illinois. We have informed our members, many of whom are Condell patients, and now our goal is to help them through this transition.
I hope Condell will join us in making this change easier for affected members. This situation began when Condell demanded a retroactive increase in reimbursement of more than 30 percent. This was an enormous demand.
Blue Cross negotiated in good faith, offering extremely reasonable increases, but Condell refused to negotiate. Had we agreed to an increase of this magnitude, our employer group customers, their employees and our individual policy holders in the Lake County area would have been forced to pay significantly more for their health care.
As the stewards of our customers' and our members' health-care dollars, we could not justify such a rate increase, and area employers agreed. Since the termination, we have been communicating the following policies to our affected members: Blue Cross and Blue Shield of Illinois is extending its PPO coverage for services at Condell through Oct. 31, and our HMO coverage for services at Condell through the end of this year.
We will continue to cover members for emergency care at Condell at the PPO level of benefits, and we have outlined our transition of care policies for people with specific conditions and for those who are receiving hospice care. Our Medicare supplement members may continue to seek care at the hospital, with no change to or impact on their benefits.
If members seek non-emergency services at Condell after the transition periods outlined above, the hospital has stated it will bill them directly for full charges. Because Condell's average inpatient bill is nearly $30,000, members who receive care from Condell could be liable for tens of thousands of dollars.
Most Condell physicians will remain in our network. We are in the process of personally contacting the remaining handful -- fewer than 15 at this point -- to discuss their options for remaining in our networks.
Additionally, all of the hospitals within 15 miles of Condell are in our PPO network: Advocate Good Shepherd Hospital, Highland Park Hospital, Lake Forest Hospital and Vista Medical Centers. To ensure our affected members fully understand this situation, we mailed them letters outlining our coverage policies for services at Condell.
We have also created a designated customer service team to handle their inquiries. We encourage our members, customers, physicians and others with questions to contact us directly to ensure they receive timely and accurate information. Again, our goal is to ensure the smoothest possible transition for our members, and I can assure our members and our customers that we are working diligently to ease them through this period.
Paul Boulis
President
Blue Cross and Blue Shield
of Illinois
Chicago