Blue Cross vs Condell

One of the biggest local hospitals in Lake County recently terminated its contract with Blue Cross Blue Shield of Illinois insurance company, one of the biggest medical insurers in our state. Or the latter terminated its contract with the former. I don’t know exactly what happened there, nor do I care about the reasons - I care only about the end result. Condell says reimbursement does not cover their costs, BCBS says reimbursement is in line with what other hospitals in the area receive. (Disclosure: My family has a policy from BCBS and Condell is the nearest hospital to Mundelein, where we live).

I find this disturbing. And not only because I personally will be inconvenienced. It looks to me like both organizations relied on ordinary people to start making phone calls and writing letters to the other party to convince them to give up and sign a new contract. The same ordinary people who often have no choice but to accept insurance offered by their employers. OK, they might have a choice after all, but it’s not economically viable - if my employer offers me insurance, I would have to decline and go buy myself another policy (this would most definitely involve lots of paperwork, fine print and probably pre-certifcation medical exams for all members of our family). It’s very unlikey that many people would choose this option. Questions that we should be asking:

  1. If Condell thinks its reimbursement does not cover its costs, are its costs above its peers? If yes, why?

  2. Does BCBS truly provide the same reimbursement to Condell as it provides to its peers? If no, why?

The bottom line - won’t it be nice to have some sort of independent moderator or arbitrator or anybody with some sort of official status to obtain answers to these questions and make them available to the public so that we all could make an informed decision? Maybe it can be a civil lawsuit whose sole purpose would be to get both companies to answer above questions under oath? Instead, they force us to rely on PR departments of both organizations who keep accusing each other.

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