Blue Cross and Blue Shield of Illinois, the state’s largest health insurer, soon will no longer administer claims and provide customer service to employees of Wal-Mart Stores Inc., the world’s largest retailer, losing the business to another Blue Cross plan in Arkansas.

Starting in January 2010, Illinois Blue Cross won’t be performing administrative functions, such as staffing customer-service call centers, for employees of Wal-Mart, the health plan confirmed. Wal-Mart employees in the state still should be able to access benefits through Illinois Blue Cross because the new contract is largely related to behind-the-scenes work, the insurer said.

Such administrative tasks will begin in 2010 to transition over to Arkansas Blue Cross and Blue Shield, Illinois Blue Cross said.

Illinois Blue Cross would not disclose the financial impact of this change. Bentonville, Ark.-based Wal-Mart has more than 1.4 million U.S. employees and is known for its clout in negotiating with its many vendors.

“The membership in our four states will still be captured as part of our market share,” Illinois Blue Cross spokesman Jack Segalsaid of its parent, Chicago-based Health Care Service Corp., which also operates three other Blue Cross plans in Oklahoma, Texas and New Mexico.

In its new role, Health Care Service’s four Blue Cross providers will “become what’s known as ‘host plans’ for Wal-Mart’s approximately 200,000 members that live in our four states,” Segal said. “As host plans, we’ll provide our [medical-care provider] networks and our discounts, continue to reimburse providers and continue to determine claims pricing.”

As a home plan, Illinois Blue Cross has 445,000 members at Wal-Mart.

Wal-Mart would not confirm the change in the contract or financial terms of its relationships with any of the Blue Cross plans that process its health care.

“We regularly assess the quality and costs of the health-care plans offered by our providers, including those plans owned by Health Care Service Corp., and we don’t have any changes to those plans to announce at this time,” said Greg Rossiter, spokesman for Wal-Mart.

But Illinois Blue Cross said, “Wal-Mart was looking to consolidate into a single platform, so Arkansas [Blue Cross] decided to take this on and become the single home plan or administrator.”

Until the transition, Illinois Blue Cross will continue to share administrative duties with the Arkansas Blue Cross plan and Blue Cross and Blue Shield of Alabama.

Health Care Service had $865 million in net income last year on $14.3 billion in premium revenue. The nation’s fourth-largest insurer, the Chicago company has 12.4 million members, including 7.4 million in Illinois.

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Effective July 13, 2008, Blue Cross Blue Shield of Illinois will no longer print and mail Explanation of Benefits (EOBs) that relate to all patient share zero liability claims. Zero liability claims are those claims that are covered and paid for by Blue Cross and Blue Shield of Illinois and do not require any additional payment by members. Zero liability claims can still be viewed and downloaded online through Blue Access® for Members at www.bcbsil.com/members.

In mid-December, 2008, Blue Cross Blue Shield of Illinois will begin to bundle all EOBs into one envelope on a weekly basis. However, any EOB accompanied by a check will be excluded from the bundling process and instead will be immediately mailed.

Tags: Blue Cross Blue Shield, EOB, green, health care, illinois insurance, insurance

By Monique Garcia | Chicago Tribune reporter

When Brianna Dicianni was diagnosed with autism two years ago, doctors said the girl would never learn to speak.

Undeterred, her family sought therapy, only to run into another roadblock: Because their insurance company didn’t cover treatment for autism, they would have to pay for the costly sessions out of pocket.

Brianna’s parents borrowed against their home, dipped into college savings for their three children and—$80,000 later—Brianna, now 5, can talk.

On Sunday, Gov. Rod Blagojevich moved to help families like the Diciannis, using his amendatory veto power to alter legislation so insurance companies would be required to cover diagnosis and various therapies for autistic children.

“The billion-dollar profits of insurance companies are being put before our children, and it’s wrong, it’s criminal,” said Brianna’s father, Peter Dicianni.

The legislation would force insurance companies to cover up to $36,000 a year in occupational, physical, speech and behavioral therapies in addition to psychiatric and psychological services. Children would be covered until they turned 21.

Proponents of the legislation said early treatment is vital to the development of children with autism. By undergoing therapy early in life, they are more likely to gain the communication and social skills needed to live independent lives.

“This is literally about whether a child can grow up and live a good and happy life, or whether a child will grow up and be in his own isolated world, unable to communicate,” Blagojevich said at a news conference announcing the legislation.

For Peter Dicianni, the governor’s action comes after more than a year of lobbying lawmakers and insurance companies to cover autism treatments. But hurdles still remain. Lawmakers in both chambers must approve the governor’s changes.

Tags: autism, blagojevich, healthcare, illinois insurance, Illinois Senate

Democrats back governor on health care

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