160 Condell doctors out of Blue Cross HMO network

Thousands of Blue Cross Blue Shield of Illinois HMO members seeking care and services from physicians affiliated with Condell Medical Center in Libertyville may be immediately out of luck.

The only physicians' group affiliated with Condell said Friday it will no longer provide services to Blue Cross HMO members and it will be disbanding, closing its doors for good.

Condell terminated its HMO and PPO contracts with Blue Cross in September and October, respectively.

Blue Cross had promised HMO members they would be covered at "in-network" rates for services received at Condell through Dec. 31.

On Thursday, though, about 160 of Condell's physicians officially became "out-of-network" for about 11,000 Blue Cross HMO members, said Beverly Brottman, executive director of Condell Health Care System's Physician Hospital Organization.

Those patients will likely stop seeking care and services at Condell because their claims will be denied, Brottman said.

The doctors who are part of Condell's physicians group were notified this week if they continue to treat Blue Cross HMO patients, they won't get paid by the group.

Given the group's heavy reliance on Blue Cross clients and the hospital breaking ties with the insurer, those doctors are expected to leave Condell's physicians' group and join other physicians' groups, Brottman said.

The doctors could continue to see their HMO patients, but they would have to bill the patient directly.

"We regret the impact of this difficult decision," Brottman said. "Basically, the bottom line is they (Blue Cross) withheld critical cash funding and therefore we can no longer pay for services, and the physicians can't provide services if they are not going to be paid. We didn't want it to come to this."

Blue Cross spokesman Jack Segal said Friday afternoon the accusation the agency was withholding payments to physicians is a lie.

"We have paid Condell Health Care System their contracted … payments throughout 2007, including September and October, contrary to CHCS' assertions," he said.

Segal said Blue Cross will inform the affected Condell physicians they can contact the agency directly to get reimbursed for services.

"Our primary goal is to ensure our members receive necessary medical services without interruption," he said.

Separately, Condell Medical Center filed a lawsuit Friday against Blue Cross in Cook County Circuit Court claiming the insurance company owes it $26 million.

Segal said the agency was unaware of the lawsuit.

These are the latest twists in a months-long rift between the two health care giants who have been in contract negotiations for a year. Both sides allege the other owes millions of dollars.

Blue Cross unsuccessfully tried to stop Condell from ending its PPO contract in October. The hospital then took heat from angry Lake County employers for failing to come to a compromise with the insurance company.

Condell is now counter-suing Blue Cross for breach of the PPO and HMO contracts. Condell accuses the insurer of not paying up for services and care already provided to Blue Cross HMO and PPO members since early June.

"Condell took this action because $26 million is too much money for us to go without," said Andrew Stefo, Condell's chief financial officer. "This money helps the hospital function every day, paying our nurses' salaries, buying medication, and purchasing equipment and technology."

Meanwhile, Blue Cross asked HMO members to pick another physicians' group by Thursday to prepare for the transition from Condell after Jan. 1. Members who did not notify Blue Cross by Thursday would automatically be assigned to a new physicians group within the network.

"If there is the need for care beyond the transition period continuing with the current physician, we would be able to make arrangements for that," Segal said.

HMO Illinois or Blue Advantage HMO members, should call (800) 892-2803.