A Tennessee family faced a potentially catastrophic situation when Joe Smith — a husband and father of four — was diagnosed with a brain aneurysm. Smith, of Chattanooga, had health insurance through his job with Blue Cross Blue Shield of Illinois, but the insurance company refused to pay for the surgery necessary to prevent a life-threatening rupture.
Sabrina Corlette, a professor at Georgetown University who studies health insurance reforms, said,"some employers are increasingly introducing these closed network plans or narrow network plans as a way to cut back on their healthcare costs." The day after the canceled surgery, the couple said Joe Smith developed a persistent headache and went to the emergency room. Joe Smith eventually received emergency surgery by Dr. Mayshan Ghiassi, who was out of network. The couple did not know whether their insurance company would cover the cost, which could have been hundreds of thousands of dollars.
In March — the same month Joe Smith was awaiting surgery — Blue Cross Blue Shield of Illinois was fined over $600,000 by the state of Illinois for violating state laws. The violations included failure to properly apply maximum driving time and distance standards to reflect the actual number of providers available. The insurance company stated that it is committed to helping its members access the care they need, where and when they need it.