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Scherer-Backed Bill Takes Aim at Ghost Networks

The Illinois State Capitol is pictured in Springfield.
Capitol News Illinois
The Illinois State Capitol is pictured in Springfield.

Commentary – Continuing her longstanding efforts to improve health insurance network adequacy and hold big health insurance companies accountable, state Rep. Sue Scherer, D-Decatur, is backing legislation that will institute new rules to improve access to care.

“Two years ago, Central Illinois saw the effects of ghost networks as thousands of people paid for an insurance plan that did not connect them with medical care within a reasonable distance from their homes,” said Scherer. “Since then, I have been hard at work to make sure that what we saw after the Blue Cross Blue Shield and Springfield Clinic fallout never happens again.”

Scherer introduced similar legislation after a dispute between Blue Cross Blue Shield of Illinois and Springfield Clinic left thousands throughout Central Illinois without access to adequate healthcare as the health insurance giant directed plan holders to providers who were either too far, retired or not accepting patients. This phenomenon, when in-network providers are simply unavailable, is referred to as a ghost network.

Now, Scherer is sponsoring House Bill 5313, which will add new requirements for health insurance companies’ network records. Health insurance companies will be required to perform network adequacy checks on their offered plans and update health provider directories throughout the year to ensure that plan holders have access to the care they need under the plan they pay for.

“No one should pay for insurance that they can’t even use because there are no in-network healthcare professionals near them,” said Scherer. “Central and Downstate Illinois communities already have a shortage of healthcare workers, and this legislation will ease that shortage and ensure that our residents can use their insurance to seek medical care just like others throughout our state.”

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