Prime Healthcare, which owns eight Illinois hospitals, may soon no longer be in-network with the state\u2019s largest health insurer, Blue Cross and Blue Shield of Illinois \u2014 a situation that could force some patients to switch doctors or pay more for care.\u00a0<\/p>\n
Blue Cross and Blue Shield of Illinois sent letters to members earlier this month informing them that Prime has \u201cnotified us that they intend for their hospitals, doctors and health care professionals to leave our networks on June 1, 2026.\u201d<\/p>\n
Prime and the insurer are in the midst of contract negotiations but have not yet come to an agreement.\u00a0<\/p>\n
Health systems and insurers periodically renegotiate contracts that dictate how much insurers will pay health systems for medical services, in exchange for a health system being included in an insurer\u2019s network.\u00a0<\/p>\n
If no agreement is reached, Blue Cross members with HMOs would no longer have coverage for health care at Prime hospitals, except in emergencies. Blue Cross members with PPOs could still get care through Prime but would have to pay more out-of-pocket for the care because it would be considered out-of-network.\u00a0<\/p>\n
\u201cWe value the care Prime provides to our members and communities and are working closely with them to come to a mutual agreement,\u201d Erika Callahan, a spokesperson for Blue Cross and Blue Shield of Illinois, said in a statement Thursday. \u201cIf an agreement is not reached by June 1, 2026, Prime Healthcare facilities, hospitals and health care professionals will no longer be in-network.\u201d<\/p>\n
When asked how many people might be affected or how many received the letters, Callahan said \u201cwe do not discuss the details of contract negotiations.\u201d<\/p>\n
A Prime spokesperson also said in a statement that Prime is \u201cactively engaged\u201d in negotiations with Blue Cross. Prime hospitals and physicians are still in-network with Blue Cross at the moment, the statement said.<\/p>\n
\u201cBCBSIL may have prematurely issued termination notices that unfortunately created confusion for patients, however our hospitals remain committed to supporting our patients and working toward a solution that protects access and continuity of care,\u201d Prime said.<\/p>\n
Prime is hopeful that Blue Cross \u201cwill honor the essential role these hospitals and physicians play in their communities and work collaboratively with us to reach an agreement that protects patients, allows quality care to continue and preserves access before any potential changes would take effect,\u201d Prime said in the statement.<\/p>\n
Prime\u2019s Illinois hospitals include Holy Family Medical Center in Des Plaines, Mercy Medical Center in Aurora, Resurrection Medical Center in Chicago, St. Francis Hospital in Evanston, St. Joseph Medical Center in Joliet, St. Joseph Hospital in Elgin, St. Mary\u2019s Hospital in Kankakee and St. Mary of Nazareth Hospital in Chicago.<\/p>\n
Prime is relatively new on the scene in Illinois, having\u00a0bought the hospitals<\/a> from nonprofit Ascension in March 2025 for more than $370 million. Prime is a for-profit company based in California and has more than 50 hospitals across the country.<\/p>\n Under the deal, six of the hospitals became for-profit, while two \u2013 St. Francis in Evanston and St. Mary\u2019s in Kankakee \u2013 kept their not-for-profit statuses as part of Prime\u2019s affiliated charity called the Prime Healthcare Foundation.<\/p>\n Since that purchase, Prime has faced criticism from lawmakers and the Illinois Nurses Association over changes it\u2019s made \u2013 though Prime says that it and the Prime Healthcare Foundation have already invested more than $104 million in infrastructure, technology and equipment at the hospitals.<\/p>\n In May, Illinois Sens. Dick Durbin and Tammy Duckworth sent a letter to the head of Prime expressing concerns<\/a>, after Prime decided to suspend inpatient pediatric care<\/a> at St. Joseph Medical Center in Joliet, and after Mercy Medical Center in Aurora lost its designation as a Level II trauma center<\/a>.\u00a0<\/p>\n Prime responded, at the time, by saying it\u2019s focused on a mission of turning around struggling community hospitals across the country, and that the Illinois hospitals were losing about $200 million a year before Prime bought them. Prime said maintaining services with low patient demand is not sustainable, nor good for the quality of care.<\/p>\n Members of the Illinois Nurses Association also criticized Prime\u2019s management of St. Joseph in Joliet at a meeting of the Illinois Health Facilities and Services Review Board this past week.\u00a0<\/p>\n At that meeting, the board voted 8-1 to approve Prime\u2019s application to spend $5.5 million to create a new outpatient surgical center in Joliet. The board\u2019s vote, however, followed public remarks by members of the Illinois Nurses Association who complained that many nurses and doctors have left St. Joseph in Joliet since Prime took over, and they decried certain cuts.<\/p>\n \u201cOur concerns are how are they going to open this facility when it seems like they are not funding and investing in the primary building that (they) purchased a year ago,\u201d said Kaitlynd French, with the Illinois Nurses Association.<\/p>\n Prime said in a statement to the Tribune on Friday that it has invested more than $11 million in the Joliet facility and equipment upgrades since buying it a year ago, and it\u2019s planning to invest another $20 million this year.<\/p>\n Before Prime bought the Joliet hospital, it was losing about $90 million a year, said Fred Ortega, a Prime spokesperson. That loss is now about half of what it was, Ortega said.<\/p>\n \u201cThe ambulatory surgery center approved by the Illinois Health Facilities and Services Review Board is intended to complement hospital services and improve access to outpatient surgical care for the community while allowing the hospital to focus resources on higher-acuity care,\u201d Prime said in the statement.<\/p>\n","protected":false},"excerpt":{"rendered":"Prime Healthcare, which owns eight Illinois hospitals, may soon no longer be in-network with the state\u2019s largest health…\n","protected":false},"author":2,"featured_media":522459,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[235556,97,252,253,235555,235557],"class_list":["post-522458","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-blue-cross-and-blue-shield-of-illinois","tag-health","tag-health-care","tag-healthcare","tag-prime-healthcare","tag-saint-joseph-medical-center"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/522458","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=522458"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/522458\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/522459"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=522458"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=522458"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=522458"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}