Illinois is kicking the insurer out of its Medicaid managed-care program, accusing the insurer of failing to meet several key standards.
By Jack Craver | April 20, 2018 at 11:29 AM
Illinois is kicking Blue Cross Blue Shield out of its Medicaid managed-care program, accusing the insurer of failing to meet several key standards for its members.
The insurer’s network of providers is too narrow and has resulted in low-income patients not having access to necessary medical services, including primary care physicians, hospitals and specialists in multiple areas of the state.
“The department has concluded that the contractor is in substantial noncompliance with the network adequacy requirements of the contract,” stated a March 21 letter from the state Department of Healthcare and Family Services to Blue Cross.
The state has also fined Blue Cross $100,000 for its failure to respond to a large number of grievances and appeals from its members. In an April 6 letter detailing the fines, the state threatened that an additional $50,000 fine would be levied for every subsequent 30-day period in which the insurer did not right its wrongs.