The Illinois Legislature has overturned the veto of a bill by Gov. Bruce Rauner that amends the state’s workers compensation law to allow medical providers to sue insurers over interest stemming from unpaid bills, among other changes hammered out in last-minute compromises.
Gov. Rauner vetoed S.B. 904 in August, but the Senate on Nov. 14 voted 55-1 to overturn his veto and went on to propose an amendment that helps create a compromise between doctors and insurers, according to several industry groups. On Tuesday, the Illinois House of Representatives voted 110-2 to overturn the veto, meaning the bill is now law and takes effect immediately.
The hotly contested bill faced strong opposition by industry groups such as the American Insurance Association and the Property Casualty Insurers Association of America when it was proposed in 2017, but was lauded by the medical community as a much-needed change to the way workers compensation bills are handled.
At stake was whether doctors treating injured workers would be able to sue insurers in circuit court for the interest collected on unpaid bills at the rate of 1% per month, among other changes to the way medical claims are managed between doctors and payers.
The latest version of S.B. 904 clears the way for lawsuits, but the attached amendment, a bill known as H.B. 3452 that was mostly unrelated to workers comp, specifies that doctors can only go to circuit court if the Illinois Workers Compensation Commission deems the injury compensable and that the insurer has all the necessary documentation or “data elements necessary to adjudicate the bill” for treatment, according to Eugene Keefe, Chicago-based partner at Keefe, Campbell, Biery & Associates LLC.
In other words, the medical treatment must be approved under workers compensation — and oftentimes the commission — before interest can be accrued and then collected via the circuit court, according to Mr. Keefe, who argued that S.B. 904 alone without the amendment would “clog” the already-taxed circuit court system in Illinois.
“The (insurers) are going to say, ‘OK, if we have no defense, then we are going to pay,’” said Mr. Keefe. “Doctors wanted to be able to collect the bill, but it has to be paid under comp and most carriers or (third-party administrators) will just say, ‘Don’t sue us — here is your statutory interest.’”
Getting paid and in a timely manner is what the medical community was after with S.B. 904, said David Kanzler, CEO of the Hinsdale, Illinois-based Hinsdale Orthopaedics Associates, which treats injured workers.
The new law also requires insurers to allow doctors to submit electronic claims to insurers, which facilitates a speedier process for providers seeking payment for care, said Mr. Kanzler. That requirement was put in place in 2011 but is “not followed” by insurers, he said.
“It’s a tremendous necessity because in the absence of the ability to enforce the law they have not been paying us on a timely basis (and) we have claims that are two years out that are approved claims and we can’t even get an explanation of benefits out of the insurance company,” said Mr. Kanzler.
Dr. David Fletcher, an occupational medicine physician who runs SafeWorks Illinois in Champaign, Illinois, called the enhanced bill “a really positive development” in that “it allows me to have enforcement of interest which is rarely if ever paid” by workers compensation insurers.
In addition to interest, the bill mandates an explanation of benefits stemming from treatment denials, according to Dr. Fletcher, who was on the task force that helped lobby for S.B. 904. “Right now we have all sorts of problems (with) authorization for patients,” and his office spends roughly $10,000 a year in postage alone, he said.
The current system with regard to billing and collecting on interest has created a health care system where “a lot of doctors were refusing to work with injured workers because of the payers,” he said.
Those representing insurers, meanwhile, deny a systematic problem with unpaid bills and say the latest push will work in favor of both parties.
“(S.B.) 904 is now better than it was,” said Steve Schneider, Deerfield, Illinois-based vice president for state affairs for the Midwest region of the Washington, D.C.-based AIA.
The latest amendment makes the bill “a little bit more manageable,” he added.
Sending providers directly to the circuit courts will “slow down the settlement of workers comp cases” because “dockets are heavily crowded,” he said.
Jeffrey Junkas, assistant vice president of state government affairs for PCI in Chicago, agreed that the new language makes the reform “a little bit more palatable” and that “we believe it is a falsehood” that doctors are universally not getting paid on time for treating injured workers.
“We do not see evidence of a statewide problem,” he said, adding that “clear-cut” cases are paid on time. But there have been instances involving some providers and insurers haggling over bills for treatment, he said.
“There have always been problems with medical providers collecting interest on unpaid bills,” but the industry wants the claims to stay in the comp system and avoid the circuit courts, said Mr. Schneider.
The industry is unsure how the reforms will play out when enacted next year, Mr. Junkas said. “If there are still issues and concerns in 2019, we will work through them,” he said.
This article was first published by Business Insurance.