Show (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 PlanIf you have a fully-funded plan, file a complaint with the Illinois Department of Insurance. Contact via Email: Self-Funded PlanIf 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 Need Help? Contact Springfield Clinic Patient Advocate TeamIf 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?
*Some employers have made arrangements allowing their employees currently enrolled in a BCBSIL PPO plan to continue accessing the Springfield Clinic Surgery Center 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. FAQsFrequently 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)
You are not impacted and will remain in-network with Springfield Clinic if you have one of the following plans:
*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)
How do I apply for reimbursement from Blue Cross Blue Shield of Illinois?Claims may be submitted one-at-a-time by entering information directly into an online claim form on the vendor portal; or batch claims may be submitted via your Practice Management System (check with your software vendor to ensure compatibility).
How do I get reimbursed for Covid test Blue Cross Illinois?If you don't have pharmacy benefits with BCBSIL/Prime, contact your health plan administrator for information about getting test kits and being reimbursed. For those with BCBSIL pharmacy benefits through Prime Therapeutics, your plan will cover the cost of FDA-authorized, over-the-counter diagnostic tests.
How do I submit a claim to Bcbsla?Customer Service. Service Inquiries (Benefits, Claims, Bill Pay and Other Service issues) 1-800-495-2583 (toll-free) ... . Fax. (225) 297-2727.. E-Mail* [email protected].. Secure Online Contact Form. Contact us 24 hours a day, seven days a week through our secure online inquiry form.. Hearing Impaired. 1-800-846-5277.. TTY Callers (TTY). What is the timely filing limit for BCBS of Illinois?BCBSIL Facility Providers
Claims must be filed with BCBSIL on or before December 31 of the calendar year following the year in which the services were rendered.
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