Home > Uncategorized > Second ICS Initiative Signed Into Law!

Second ICS Initiative Signed Into Law!

Today Governor Quinn Signed House Bill 1193 creating the first limits in Illinois on how insurance companies may recollect funds already paid to our doctors. It took three years of negotiations and we recruited the help of over 20 other groups, but we are now seeing the beginning of the end for overly aggressive recoupment practices in our state. Unlike our scope bill, this does NOT have an immediate effective date and instead does not become law until January 1st, 2012.

Illinois will no longer be one of the few remaining states with ZERO restrictions on insurance recoupment practices. The ICS is fighting to see the end of recoupments spanning a decade and hundreds of thousands of dollars for what may simply be a mistake or difference of opinion. In short, the bill prevents the recoupment of funds from healthcare providers beyond 18 months (exceptions only for proven fraud, double payment, or for CHIP plans). In fact, the language of the bill specifically prevents a contract between an insurer and health care professional in violation of this law.

“No recoupment or offset may be requested or withheld from future payments 18 months or more after the original payment is made, except in cases in which: (1) a court, government administrative agency, other tribunal, or independent third-party arbitrator makes or has made a formal finding of fraud or material misrepresentation; (2) an insurer is acting as a plan administrator for the Comprehensive Health Insurance Plan under the Comprehensive Health Insurance Plan Act; or (3) the provider has already been paid in full by any other payer, third party, or workers’ compensation insurer. 

No contract between an insurer and a health care professional or health care provider may provide for recoupments in violation of this Section…”

See the final language for the entire act here:  http://ilga.gov/legislation/publicacts/97/PDF/097-0556.pdf

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Categories: Uncategorized
  1. August 25, 2011 at 11:44 pm

    Another one bites the dust, ya’ another one bites the dust… 😉 The ICS staff is smokin’!

    Thanks for all the hard work.

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