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Ottawa committee flags BCBS billing shift and ambulance charge errors; mayor seeks data for OSF review
Summary
On May 11, 2026, Ottawa’s Insurance Committee was told Blue Cross Blue Shield will require biosimilar drugs and shift to a weekly billing cycle with 48‑hour payment terms; committee leaders said the new timeline may conflict with the City’s non‑home‑rule payment process and asked Horton for ambulance‑claim data to raise with the OSF Board.
The City of Ottawa Insurance Committee on May 11 was warned that Blue Cross Blue Shield plans will soon require members to use biosimilar drugs for certain name‑brand therapies and that BCBS is moving from a 30‑day payment window to a weekly billing cycle with payments due within 48 hours, including weekends.
Horton broker Jim, who presented market and claims trends to the committee, said the biosimilar requirement will affect medications such as Skyrizi and Humira and that members who cannot tolerate the biosimilar may still access a name‑brand drug only through BCBS’s formal appeals process. Jim also reported the billing‑cycle change is being applied uniformly and that at least one client’s request for an exception was denied.
Mayor Robb Hasty and Commissioner Eric Ganiere told Horton they were concerned the accelerated payment schedule could conflict with the City’s statutory requirement that certain payments await City Council approval because Ottawa is a non‑home‑rule municipality. The minutes record that both officials said the rapid 48‑hour turnaround would be challenging to reconcile with the City’s internal approval process.
Committee members also heard that several claims are being adjusted because of incorrect initial processing tied to ambulance transports. Horton attributed the errors in part to patients being taken first to Ottawa OSF and then transferred to other facilities—Peru, Peoria, Mendota and Bloomington—after Ottawa OSF no longer offers the full range of services; that transfer pattern has led to duplicate or inaccurate ambulance bills, the presentation said.
Mayor Hasty requested detailed numerical data on ambulance‑related claims from Horton—both for the City’s plans and for other Horton clients in the region—so he and Commissioner Ganiere can raise the discrepancies with the OSF Board. The committee did not take formal action during the meeting beyond recording the request; Horton said the BCBS billing policy is currently being applied uniformly to its clients.
The committee scheduled additional meetings ahead of the Sept. 1 insurance‑plan lock deadline to review renewal options and operational impacts. The committee’s next steps include obtaining the ambulance‑claims data requested by the mayor and evaluating whether any administrative or contractual steps can reduce the risk of late fees under BCBS’s new billing cadence.
