What's Going On?
First and foremost, all of OSF HealthCare is participating in the Blue Cross Blue Shield PPO network through the end of 2017. Patients are encouraged to continue to use our services through the remainder of the year.
On October 2, Blue Cross Blue Shield of Illinois (BCBSIL) terminated three of our hospitals from its PPO network: OSF HealthCare Saint Francis Medical Center in Peoria; OSF HealthCare Saint Anthony Medical Center in Rockford; and OSF HealthCare St. Mary Medical Center in Galesburg.
The termination issued by BCBSIL is effective January 1, 2018.
By removing these hospitals from its network, BCBSIL eliminates important referral centers and patient access to advanced, critical services within OSF HealthCare.
This action by BCBSIL reduces the ability to care for the sickest and most vulnerable patients and, as such, left OSF no choice but to terminate agreements with most of its other hospitals.
What You Need to Do
Blue Cross Blue Shield patients who still wish to use OSF hospitals after December 31, 2017 can share their concerns with their employer or by calling Blue Cross Blue Shield Customer Services at (800) 538-8833.
For a complete listing of other insurance companies and products accepted by OSF hospitals, please use the links below.
Frequently Asked Questions
- How does the BCBSIL termination affect me now?
- Patients who currently participate in BCBSIL commercial PPO networks have full in-network access to all OSF HealthCare facilities and services until December 31, 2017.
- When is the BCBSIL termination effective?
- Effective January 1, 2018, all OSF hospitals in Illinois, except for OSF HealthCare Saint Anthony’s Health Center in Alton, will not be included in the BCBSIL commercial PPO networks.
Unless they have other coverage, patients enrolled in BCBSIL PPO network products would have to use their out-of-network benefit for care at the OSF hospitals.
- Which OSF Illinois hospitals are part of this BCBSIL termination?
The following OSF entities are affected by the BCBSIL termination:
- OSF HealthCare Saint Anthony Medical Center, Rockford
- OSF HealthCare Saint James-John W. Albrecht Medical Center, Pontiac
- OSF HealthCare Saint Elizabeth Medical Center, Ottawa
- OSF HealthCare Saint Paul Medical Center, Mendota
- OSF HealthCare St. Joseph Medical Center, Bloomington
- OSF HealthCare Saint Francis Medical Center, Peoria
- OSF HealthCare St. Mary Medical Center, Galesburg
- OSF HealthCare Holy Family Medical Center, Monmouth
- OSF HealthCare Saint Luke Medical Center, Kewanee
OSF HealthCare Saint Anthony’s Health Center in Alton, Illinois, is NOT affected by this BCBSIL termination.
- What BCBSIL products were terminated?
- The BCBSIL Commercial, PPO, EPO and Blue Choice products were all part of the termination.
- Is it true that OSF demands exclusive contracts and would not allow BCBSIL to enter into agreements with other hospitals?
- No. BCBSIL has long been free to negotiate and enter into agreements with any providers it chooses.
- Does this termination also affect outpatient hospital services?
Yes, the termination by BCBSIL will affect all outpatient hospital departments and services, including, but not limited to diagnostic testing, audiology, sleep studies, rehabilitation, and ambulatory surgery.
Outpatient services provided at non-hospital facilities, such as OSF PromptCare or primary care physician visits, are not affected by the BCBSIL terminations.
- If an individual is in Open Enrollment, how do they switch to a new plan?
- If an employer has multiple options available during open enrollment, our OSF hospitals are participating in many other national and local managed care plans. Please refer to the OSF website for the list of the plans that OSF is participating with at this time.
- If an individual is NOT in Open Enrollment, how do they switch to a new plan?
- If individuals are not currently in Open Enrollment, they will need to contact their employer’s human resource department to determine their options. If they are able to change plans, they may refer to the OSF website for the list of other plans that OSF is participating with at this time.
- Are the OSF physician providers and OSF Home Care still in network for BCBSIL?
- We anticipate that many OSF physicians will remain in the BCBSIL network, but some physicians may be unable to participate in the BCBSIL PPO products based upon the hospitals where they have admitting privileges.
We will be discussing this with BCBSIL to determine which, if any, physicians will be impacted.
OSF Home Care is still in network.
- What other managed care payers does OSF participate with?
- OSF participates in many national and local managed care payers, including most other major insurance companies. A full listing of our managed care contracts is available on the OSF website.
- What if a patient is currently getting treatment that will go past January 1?
- If a patient is currently receiving treatment that is scheduled to go past January 1, unless they have other potentially applicable coverage, they will need to contact BCBSIL to find out if they will continue to cover treatment at our facilities as part of in-network benefits.
If the patient needs to switch providers, OSF will work collaboratively with BCBSIL and the new provider to ensure a safe and clinically appropriate transition of care.
- Are services considered out-of-network on or after January 1 if a patient comes to an OSF facility that was terminated?
- BCBSIL must cover emergency services even at out-of-network facilities in accordance with all state and federal laws. However, absent special authorization by BCBSIL, for all other services the BCBSIL terminated facilities will be considered out-of-network.
- How will this affect patient co-payment and deductibles?
- Co-pays and deductibles will vary for any out-of-network services depending on the specific plan selected. Individuals should reach out directly to their insurance provider to determine specific benefits available in order to keep care at one of these OSF hospitals.
- If a patient needs to have a procedure, can their doctor send them to their local OSF hospital?
- A patient’s doctor can send them to a local OSF hospital. However, unless the individual has other applicable coverage, the costs associated with the procedure will be considered out-of-network and may not covered by BCBSIL.
- How can a BCBSIL member request that Blue Cross allow participation of the OSF hospitals?
- We appreciate the desire to have access to our OSF hospitals and to the entire OSF HealthCare system of coordinated care that takes seriously the quality, cost, and experience for each one of our patients.
BCBSIL members can contact their local human resources department regarding other insurance company choices or express their desires to the Blue Cross Blue Shield Customer Service phone number at (800) 538-8833.
- What about OSF HealthCare Children’s Hospital of Illinois? If an individual has a high-risk pregnancy and is due to deliver at OSF Saint Francis because of their NICU, will this be covered?
- After January 1, 2018, BCBSIL PPO patients using the NICU at Children’s Hospital will be out of network but will receive appropriate care under clinically appropriate discharge protocols.
After discharge, these patients may continue to use OSF using their out of network benefits or other potentially applicable coverage they may have. Patients should consult with their insurance company on coverage.
- Do you anticipate coming to agreement with BCBSIL prior to termination?
- OSF is open to future discussions with BCBSIL, but is too early to anticipate the outcome of this termination by BCBSIL. BCBSIL gave notice of this termination in the midst of ongoing discussions and without providing any advance notice.
It is our hope that BCBSIL will realize the value of having OSF hospitals in its network for its members, and enter into a new agreement.
- BCBSIL terminated three of the OSF hospitals, so why has OSF terminated six other hospitals?
- By eliminating OSF HealthCare Saint Anthony Medical Center in Rockford, OSF HealthCare Saint Francis Medical Center in Peoria, and OSF HealthCare St. Mary Medical Center in Galesburg, BCBSIL significantly restricts our ability to care for those we have been called to serve.
This causes the elimination of important referral centers and patient access to advanced, critical services within the OSF HealthCare system. In short, it impacts our ability to care for the sickest and most vulnerable patients.
Without access to our terminated hospitals for our patients, BCBSIL has, in essence, forced OSF to terminate most of our remaining BCBSIL hospital agreements.
- What if an individual is in another Blue Cross plan that is outside of Illinois?
- BCBSIL networks accessed by BCBS plans outside of Illinois would be considered out-of-network for the OSF facilities affected by this BCBSIL termination as of the termination effective date.
- What if an individual has BCBSIL Commercial, PPO/EPO, or Blue Choice as their secondary insurance?
- Individuals should review the BCBCIL website for determination of benefits and eligibility of coverage.
Specific plan information can be obtained by dialing the phone number on the back of the individual’s insurance card.
If they have other coverage, such as through a spouse’s employer or a government benefits program, OSF may be participating with that other insurance coverage. Therefore they may be able to access OSF hospitals on an in-network basis through that other coverage.
- Does this affect Medicare Select products?
- No, it does not affect Medicare Select products. Patients may continue to use OSF hospitals and their OSF physician as before. BCBSIL has terminated only commercial products, including all PPO, EPO and Blue Choice products.
The Medicare Select products are supplemental products to traditional Medicare and are not affected by this termination.
- What should patients with BCBSIL products do?
- Patients who wish to use OSF hospitals can speak to their employer to learn what provisions are being made for employees who are BCBSIL members. Patients can visit the OSF website for a complete listing of other insurance companies and products accepted by the OSF hospitals.
BCBSIL members can contact their local human resources department regarding other insurance company choices or express any concerns to the Blue Cross Blue Shield Customer Service phone number at (800) 538-8833.