Rockford Memorial waives penalties for Blue Cross Blue Shield of Illinois members

Rockford Memorial Hospital will continue to serve Blue Cross Blue Shield of Illinois members, despite being unsuccessful in contract talks with the insurer. After six months of negotiations, Blue Cross Blue Shield of Illinois is once again limiting its members’ access to Rockford Memorial Hospital. But beginning Jan. 1, 2006. Rockford Health System will waive out-of-network penalties for Blue Cross Blue Shield patients.

Rockford Health System is putting in place a program that will waive out-of-network financial penalties imposed by Blue Cross Blue Shield on its members receiving services at Rockford Memorial Hospital. “While an equitable contract with Blue Cross was what we had hoped for, we will not close our doors to these patients,” says Gary Kaatz, president & CEO, Rockford Health System. “I am sincerely disappointed that we have been unable to partner with Blue Cross Blue Shield of Illinois to provide quality health care in this community,” adds Kaatz. “We earnestly and in good faith attempted to negotiate fair and reasonable rates for our services. The rates we offered were consistent with those accepted by other major payers.”

“It became very apparent in the bargaining process to include us in the PPO Network, Blue Cross wanted rates below our costs,” said Joseph Smith, director of Managed Care, Rockford Health System. “No business can responsibly accept payment below cost and remain financially viable and continue to serve the community into the future.”

Currently, Rockford Memorial Hospital is out-of-network to those insured by Blue Cross. It has made it difficult for those needing services provided only by Rockford Health System in the region. Those services, representing the highest level of care, include a Level III Neonatal Intensive Care Unit and a Pediatric Intensive Care Unit. Blue Cross patients who utilize these services have been paying higher out-of-network costs, except for those cases requiring emergency services.

According to its own Web site and the new Blue Cross Blue Shield of Illinois Blue Star Hospital Report, the insurer recognizes the high quality of care provided at Rockford Memorial Hospital. The hospital receives high marks for member satisfaction, higher than either of its two competitors in Rockford. When viewing overall quality comparison data on the Blue Cross Blue Shield Web site, Rockford Memorial Hospital ranks among the best hospitals in Illinois, when it comes to low complication and mortality rates for both the Level III Neonatal Intensive Care Unit and cardiac services. Those two services have traditionally had the highest volumes of Blue Cross patients. The exceptional quality of care at Rockford Memorial Hospital is also reflected in its 2005 HealthGrades Distinguished Hospital for Clinical Excellence Award and in its Solucient Top 100 Performance Improvement Leader Hospital Award.

Rockford Health System has a strong tradition of partnering with insurers to provide high quality, affordable care in our community. Today, the system has a contract with every major insurer in the state of Illinois, except Blue Cross.

“Blue Cross Blue Shield of Illinois patients are more than welcome to receive care at Rockford Memorial Hospital,” says Kaatz. “We will make it as easy to come here as to any other provider in the region. We welcome Blue Cross Blue Shield patients and pledge to them our best efforts in meeting their ongoing medical needs.”

Rockford Health System’s medical group, Rockford Health Physicians, remains in the Blue Cross Blue Shield network.

From the Nov. 30-Dec. 6, 2005, issue

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