The costly and controversial Illinois workers’ compensation system is on the verge of change after healthcare professionals urged amendments to senate bill 904 – the Illinois Workers’ Compensation Act.
The Illinois State Medical Society (ISMS) and the Illinois Health and Hospital Association (IHA) requested three changes to SB 904 in order to address what they call in official IHA documents “a growing crisis of unpaid workers’ compensation medical bills, a crisis that could threaten the health of our workers’ compensation system and injured workers in Illinois.”
Medical professionals appealed to the senate for the ability to file claims in circuit court to collect interest on payments not received for services rendered to injured workers. They also asked that workers’ compensation insurers abide by the law requiring them to use electronic billing for workers’ compensation claims and that insurers send an Explanation of Benefits to medical providers explaining how they made decisions on care.
“What is happening now is that despite the fact the insurer will authorize the medical care (through a paper notification), they are now delaying payment until the claim at the Workers’ Compensation Commission is resolved, which can take as long as three years. Without a way to collect interest, the medical provider is simply on the hook for the costs of the care,” the IHA document reads.
However, some believe the proposed amendments to SB 904 could actually increase costs and dump lots more pressure on the already expensive and controversial Illinois workers’ compensation system. Steve Schneider, the American Insurance Association (AIA)’s vice president for State Affairs in the Midwest Region, described the situation as “a mess.”
“If these amendments are passed into law, whenever there’s a dispute about a medical bill and the possibility that interest may be owed on that bill, healthcare providers would be able to take that case to court. That means insurers would not be able to close out the underlying workers’ compensation claim with the Workers’ Compensation Commission. It could take a really long time for a claim to be settled because the Commission will have to wait for the circuit court case to conclude – and circuit court can be notoriously slow. If you can’t close out a claim, that’s when it becomes very expensive,” Schneider told Insurance Business.
The AIA has suggested an alternative solution whereby an appeal procedure is built into regulation under the Workers’ Compensation Commission for medical providers to solve issues around payments, as long as they have substantial evidential proof. The AIA partly modelled this suggestion around the systems in neighboring states but it was rejected as an “insufficient solution” to the problem.
“The other message we want to deliver is that this system is about workers’ compensation, not doctors’ compensation or insurers’ compensation,” Schneider added. “It’s about injured workers being compensated and having their medical bills paid fairly and promptly. I believe the injured worker has been left out of the conversation. This is a lose-lose for everyone.”
Amendments to SB 904 passed through the senate and are now pending with Republican Governor Bruce Rauner.
This article was first published by Insurance Business.