Complaint Options for Reimbursement
(Updated 3/30/22) Springfield Clinic patients who are on file with BCBSIL PPOas their primary insurance may receive this notification via email and/or letter.
Dear Patient,
You are receiving this letter because you may be eligible for some reimbursement of your health care claims. Specifically, legislators have recently called for Blue Cross Blue Shield of Illinois (BCBSIL) to reimburse patients who have been treated as out-of-network by BCBSIL for services provided by Springfield Clinic. These calls have come as the result of BCBSIL terminating Springfield Clinic as an in-network provider for their PPO members, and doing so without the required network adequacy to meet patient need. To be eligible for reimbursement, you may need to file a complaint with one of two regulatory agencies.
If you think your claim has been processed incorrectly by BCBSIL or if you’re having issues getting appointments with providers outside Springfield Clinic, we encourage you to take the following steps.
NOTE: Ask your HR administrator if your plan is fully-funded or self-funded so you know which path to take.
Fully-Funded Plan
If you have a fully-funded plan, file a complaint with the Illinois Department of Insurance.
Contact via Email:
[email protected]
Call IDOI with questions:
877.527.9431 (Press 4 for health insurance questions.)
Self-Funded Plan
If you have a self-funded plan, file a complaint with the U.S. Department of Labor.
Call Employee Benefits Security Administration (EBSA): 1.866.444.3272
(Press 2 to
talk to your regional office.)
Need Help? Contact Springfield Clinic Patient Advocate Team
If you need help with this process, please contact the Springfield Clinic Patient Advocate Team at 217.391.7086 with any questions about your bills or insurance claims. Hours are Monday-Thursday 8 a.m.- 7 p.m., Friday 8 a.m.-5 p.m. and Saturday 8 a.m.- 12 p.m.
What Can I Do?
If Springfield Clinic is out-of-network for your insurance plan, call us to discuss whether our self-pay options may help you manage costs. Our Patient Advocate Center hours are are Monday-Thursday 8 a.m.- 7 p.m., Friday 8 a.m.-5 p.m. and Saturday 8 a.m.- 12 p.m.. Call 217.391.7086 to get your questions answered and discuss financial options.
Continue to see your Springfield Clinic provider using your out-of-network benefits. Find out from your HR benefit plan administrator what your BCBSIL out-of-network benefits will be after Nov. 17, 2021*.
Talk to your employer’s HR benefit plan administrator to learn more about your in-network participation options. We accept more than 13 major health care insurance plans, and you can view all available plan options at www.springfieldclinic.com/insurance
Explore Continuity of Care coverage with BCBSIL if your ongoing treatment (i.e., pregnancy, cancer treatments) may qualify for this exception during this transition time.
If you have any questions about your bill, please contact our Patient Advocate Center at 217.391.7086 and check out FAQs below including information on the no surprise billing act and how it impacts our patients.
*Some employers have made arrangements allowing their employees currently enrolled in a BCBSIL PPO plan to continue accessing the Ambulatory Surgery and Endoscopy Center (ASC) and seeing their Springfield Clinic provider at in-network cost sharing rates after Nov. 17. Contact your HR administrator to determine if your employer has made such an arrangement.
FAQs
Frequently asked questions about Blue Cross and Blue Shield of IL (BCBSIL) PPO
What paperwork do I need to complete to schedule a procedure at an in-network facility with an out-of-network provider?
How is my bill impacted when I receive care from an out-of-network provider at an in-network facility?
Will a patient be billed for a COVID-19 test if they elect the self-pay option when their insurance is out-of-network?
Why is Springfield Clinic no longer participating with Blue Cross and Blue Shield of IL (BCBSIL) PPO* plans?
Is there any chance of resolution with BCBSIL regarding the PPO or Choice plans?
Why was this decision made?
When does the termination of the Blue Cross Blue Shield PPO plans take effect?
If I have Medicare or Medicaid primary, secondary or supplemental health care plans through BCBS how I am impacted?
Can I still see my Springfield Clinic doctor if I have Blue Cross Blue Shield of IL insurance?
What can I do if my BCBSIL insurance plan coverage is affected?
How is my radiology bill at a Memorial Health hospital facility impacted when read by an out-of-network provider?
I am currently in the middle of care and treatment. Can I continue to see my Springfield Clinic provider?
If I choose to remain with BCBSIL, what other in-network providers can I see for care?
If I want to keep seeing my Springfield Clinic provider(s), how much should I expect to spend for out-of-network costs?
Why are other PPOs accepted but not this one?
Who can I lodge a complaint with?
Why did I receive a patient letter?
I am having trouble getting appointments with providers outside Springfield Clinic, what can I do?
My insurance claim has been processed incorrectly by Blue Cross Blue Shield, what can I do?
Who can I talk to at the Illinois Department of Insurance about my complaint against Blue Cross Blue Shield?
Who at Springfield Clinic can I talk to about my incorrect claim or bill?
Frequently asked questions regarding the Blue Cross and Blue Shield of IL (BCBSIL) Choice plan
Can I still see my Springfield Clinic doctor if I choose the Blue Cross Blue Shield Choice plan?
What are my options if I purchased Blue Cross Blue Shield Choice on the Exchange?
What insurance plans will Springfield Clinic be accepting as in-network for State of Illinois Employees effective July 1, 2021?
Blue Cross Blue Shield indicates that the Choice contract ends on November 17 and Springfield Clinic says July 1. Are services provided at Springfield Clinic in-network or out-of-network from July 1 through November 17, 2021?
Am I Affected?
If you have BCBSIL Commercial PPO* (primary or secondary)
As of Nov. 17, 2021, any visit with Springfield Clinic providers will be out-of-network. This applies to all 600+ of our providers and all clinic locations and services.
As of Aug. 19, 2021, you will be out-of-network for services obtained at the outpatient Ambulatory Surgery and Endoscopy Center in Springfield.
*Some employers have made arrangements allowing their employees currently enrolled in a BCBSIL PPO plan to continue accessing the Ambulatory Surgery and Endoscopy Center (ASC) and seeing their Springfield Clinic provider at in-network rates after November 17. Contact your HR administrator to determine if your employer has made such an arrangement.
You are not impacted and will remain in-network with Springfield Clinic if you have one of the following plans:
Blue Cross Community Health Plan (Medicaid)
Blue Cross Community Medicare Medicaid Alignment Initiative (MMAI)
BCBS HMO Illinois UnityPoint 457 (Peoria Specialty Providers Only)
BCBS Medicare Supplements
*If you have BCBSIL Medicare or Medicaid as a primary, secondary or supplementary insurance the details are more intricate and will vary based on your type of insurance plan. If you have Medicare as your primary insurance and a BCBS Federal Employee Plan as secondary, please call our Patient Advocate Call Center to discuss whether you're affected or not.
If you have BCBSIL Choice (primary or secondary)
As of July 1, 2021, any visit with Springfield Clinic providers will be out-of-network.
While Blue Cross Blue Shield Choice Members are out-of-network July 1, Blue Cross Blue Shield ultimately decides whether to process a claim at the in-network or out-of-network rate. We recommend that patients call the phone number on the back of their member cards to determine which network rate will apply to the visit/procedure/service. If you have any other BCBS Secondary or BCBS Medicare Advantage you will need to check with BCBS.