Feb. 24 at 11:23 a.m.
Filed under:
Insurance
By Bruce Japsen
Blue Cross and Blue Shield of Illinois health plan members are facing higher out-of-pocket costs if they see a physician not in the health plan’s network under a new doctor payment system being rolled out by its parent company.
Chicago-based Health Care Service Corp., the nation’s fourth-largest health plan, has begun basing its doctor fee schedules on the lower rates paid by the Medicare health insurance plan for the elderly. Exactly how much more a patient will pay for out-of-network will vary. But the AMA said Medicare rates are often 20 percent below the cost of providing medical-care. Get the full story »
Feb. 24 at 10:00 a.m.
Filed under:
Health care,
Investigations,
Litigation
By Bruce Japsen
Illinois’ largest health insurance company will pay $25 million to settle allegations that it denied coverage to sick children in need of nursing care by “fraudulently” shifting their claims to Illinois’ Medicaid program, state and federal prosecutors said this morning.
The settlement, reached by Illinois Attorney General Lisa Madigan and U.S. Attorney Patrick Fitzgerald, follows several years of complaints from patients and their families. The patients reached out to Madigan’s office after their claims were denied by Blue Cross and Blue Shield of Illinois.
The cost of the medical care, which included so-called private-duty nurses for sick children and other ill patients, should have been covered by Illinois Blue Cross, but instead was shifted to Medicaid at a cost of nearly $12 million, prosecutors said. The claims were denied based on “internal, undisclosed guidelines that were more restrictive than the language provided to patients in plan policy materials,” Madigan’s office said. Get the full story »
Feb. 1 at 7:43 a.m.
Filed under:
Health care,
Hospitals,
Insurance
By Bruce Japsen
Reducing costly re-admissions to hospitals is the goal of a new initiative being rolled out this year by Illinois’ largest health insurer and the state’s hospital lobby.
By 2014, Blue Cross and Blue Shield of Illinois and the Illinois Hospital Association say they hope to reduce re-admissions by 33 percent. In 2009 there were more than 50,000 re-admissions to the approximately 200 hospitals in the state. Get the full story »
Jan. 5 at 1:09 p.m.
Filed under:
Health care,
Insurance
By Bruce Japsen
Blue Cross and Blue Shield of Illinois has dropped a plan to require health plan subscribers to get prior approval before getting access to a broad range of outpatient mental health services, amid intense criticism.
Blue Cross and Blue Shield of Illinois upset mental health providers and their patients throughout the state in recent weeks with a requirement that preferred provider organization, PPO, health plan subscribers first call the insurer to get prior approval before being able to get most outpatient mental health counseling, psychotherapy or other outpatient medical health services. Get the full story »
Oct. 6, 2010 at 7:00 a.m.
Filed under:
Health care,
Insurance
By Bruce Japsen
The state’s largest health insurer and the area’s biggest medical-care provider have signed an agreement that holds doctors and hospitals more accountable for performance and quality service.
The three-year deal between Blue Cross and Blue Shield of Illinois and Advocate Health Care, which operates 10 hospitals in Illinois, calls for Advocate to limit rate increases it negotiates from the insurance company. In addition, Advocate doctors and hospitals are being asked to meet performance targets tied to improved quality, safety and efficiencies of the medical care provided to patients covered by Illinois Blue Cross HMO and preferred-provider organization products. Get the full story »
