It’s just a (dental) bill
Tuesday, Mar 7, 2017 - Posted by Rich Miller
* Tom Lisi…
Dr. Ronald Lynch runs a family dentistry in Jacksonville. He says approximately 20 percent of his patients are state workers. Because Illinois is still running with no budget, the state has not been paying its employees’ health bills on time — and the delays are growing.
Lynch says he’s currently waiting on about $170,000 in bills from the state of Illinois. That’s all from care he’s already given to patients who work for the state. The last payment he received from Illinois was for work he did in November of 2015.
That means a state employee went to see Lynch just after the Kansas City Royals won the World Series, and Lynch has only recently gotten paid for it.
Some dentists around the state have already resorted to asking state workers to cover the cost of care up front. That way, they argue, at least the burden is spread over many patients, not funneling into their dental practices.
That reasoning is behind new legislation forwarded by an Illinois dental industry group. The proposal would make it easier for dentists who work in the same insurance network as state workers to stop taking on the liability of all these unpaid bills. […]
It may help practices like Lynch’s, but not all. Dr. Elizabeth Knoedler is a dentist in Springfield with Prairie Dental Group. She says 60 percent of Prairie’s patients are state workers, and most of them would not be able to afford to pay out of pocket, and then wait the many months to be reimbursed by Illinois.
* The bill is SB 634 and has bipartisan co-sponsorship. From its synopsis…
Amends the State Employees Group Insurance Act of 1971. Provides that the failure of the State of Illinois to adequately reimburse a dental provider for a period of 6 months from the date a claim was submitted may be considered by the provider to be a material breach of any associated participating provider contract utilized by the State for its employees. Provides that a dental provider who has an existing contract that provides services to State employees under this Act and who has not received timely reimbursement for services for a period of 6 months: (1) may consider the associated provider contract null and void for the State of Illinois; (2) may opt out of the obligation to provide services under the terms and conditions of the associated provider contract without penalty by the State or the administrator of the dental plan including any provision that allows for termination from any other commercial plans administered by the dental insurer without cause; and (3) shall, upon providing notice, be deemed an out-of-network provider from that time forward. Effective immediately.
Thoughts?
- Piece of Work - Tuesday, Mar 7, 17 @ 10:05 am:
So, most state workers couldn’t pay for a routine check-up and cleaning, which costs $75-$125? Why would that be?
- downstate commissioner - Tuesday, Mar 7, 17 @ 10:06 am:
Doesn’t affect me, but: RAUNER!!!
- up2now - Tuesday, Mar 7, 17 @ 10:09 am:
Does the bill also make the employee responsible to pay the balance immediately? Heck, why not? Health insurance next?
- Demoralized - Tuesday, Mar 7, 17 @ 10:09 am:
PoW:
Please. The issue would be (and is for those employees whose dentists currently require upfront payment) dental work with significant costs.
- Johnnie F. - Tuesday, Mar 7, 17 @ 10:10 am:
Why limit it to dental services, what about Rx drugs, medical and vision benefits too? Great example of the cadillac health plans for state workers look like.
- Demoralized - Tuesday, Mar 7, 17 @ 10:11 am:
I don’t have a problem allowing them to terminate the provider contract if they aren’t being paid.
- Thoughts Matter - Tuesday, Mar 7, 17 @ 10:12 am:
It’s not the routine check-ups that is the issue( although that and x-rays would add up for a family of 4). It’s the vanities, crowns, root canals, and iorthodontia.
I know co-workers whose dentists aren’t in this network, and who have paid thousands of dollars up front already.
- thoughts matter - Tuesday, Mar 7, 17 @ 10:13 am:
typing on the phone, sheeesh.
cavities, and orthodontia.
- Curl of the Burl - Tuesday, Mar 7, 17 @ 10:22 am:
Demoralized - but by law and by AG Madigan’s directive medical providers are not allowed to refuse any payment offers. So if a state worker tells his or her dentist that he or she can only afford $25 a month to make a balance whole the dentist cannot turn down that offer. Too many people get railroaded by the “pay now or else!” threat that they forget their patient’s rights. For reference: http://www.ilga.gov/LEGISLATION/ILCS/ilcs3.asp?ActID=2798&ChapAct=210%26nbsp.
- Tch02 - Tuesday, Mar 7, 17 @ 10:24 am:
Let’s not forget, insurance premiums are being deducted from employee paychecks … That’s the point of having insurance, right?
The state, once again (pensions anyone?), Is not holding to their end of the contract.
- WhoKnew - Tuesday, Mar 7, 17 @ 10:25 am:
This is a mess.
Tried using a prepaid Medical/Dental account. The card company wanted an EOB (Estimation of Benefits) to justify the $150 expenditure. Tried to get it from Delta Dental (the states Dental Provider network), but couldn’t because they don’t process the request for 12 or 13 months.
Had to cough up the cash to keep the prepaid account active. UGGGGH!!!!!!!
- Demoralized - Tuesday, Mar 7, 17 @ 10:27 am:
WhoKnew:
You can get them online at Delta’s website (though you have to know exactly where to go; they aren’t the easiest to find). Not sure why Delta wouldn’t help you.
- Demoralized - Tuesday, Mar 7, 17 @ 10:28 am:
And you can get them right away. You don’t have to wait a year before they show up.
- Ben - Tuesday, Mar 7, 17 @ 10:31 am:
Curl of the Burl - That only applies to hospitals.
- Anon - Tuesday, Mar 7, 17 @ 10:33 am:
Sounds like a money grab by the dentists.
- Southern Dawg - Tuesday, Mar 7, 17 @ 10:42 am:
As an employee of a state university, I would ask lawmakers to pass this bill as soon as possible. I’m paying money month after month without getting the promised benefits. I’m being ripped off…the state is stealing my money.
- Anonymous - Tuesday, Mar 7, 17 @ 11:25 am:
@Southern Dawg - Tuesday, Mar 7, 17 @ 10:42 am:
=As an employee of a state university, I would ask lawmakers to pass this bill as soon as possible. I’m paying money month after month without getting the promised benefits. I’m being ripped off…the state is stealing my money.=
If they pass this bill you will continue paying money month after month and now have to provide payment to your dentist before services.
- Annonin' - Tuesday, Mar 7, 17 @ 11:36 am:
Had Wingman won shoe would have danced Dr. Lynch over to the bankers at Vendor Assistance and found some razzle dazzle to get some cash into the doc’s pockets.
- WhoKnew - Tuesday, Mar 7, 17 @ 12:18 pm:
- Demoralized -
Thanks for the encouragement. Went back & tried again. Finally talked with someone in the know and got my EOB.
Definitely now an easy Path to get to it!
Thanks again.
- State Worker In Need of Dental - Tuesday, Mar 7, 17 @ 12:25 pm:
I took my two young kids to the dentist for a cleaning and had to pay up front. They had cleanings and fluoride treatments, one had routine x-rays. It was $600. Obviously the insurance has “allowable costs” and discounts, but for me, I just had to pay full price and wait (and wait, and wait) to be reimbursed. I haven’t been to the dentist myself for a year and a half because my dentist makes me pay out of pocket, and I can only afford to wait for so many reimbursements, and my kids’ teeth are more important. It’s depressing.
- Anon - Tuesday, Mar 7, 17 @ 12:30 pm:
Awful situation. Terrible that the dentists want to inflict this fiscal hardship on state employees and their families! State worker in need of dental’s post nearly brought me to tears. How can we allow this impasse to fall on the backs of state employees?
- AnonAnon - Tuesday, Mar 7, 17 @ 12:32 pm:
I wonder what would happen to a private company that self funded its insurance if it didn’t pay on claims for two years or so?
I am sure the State has an exemption somehow, but it is beyond absurd they are allowed to do this (among many other things).
- Anon - Tuesday, Mar 7, 17 @ 12:36 pm:
@ Anon. I understand how you feel, but it is hard to blame the dentists. How can they be expected to absorb large sums of money for years at a time. The blame is on the State for years of neglecting to properly fund employee healthcare.
- lost in the weeds. - Tuesday, Mar 7, 17 @ 12:48 pm:
pay for state dental insurance (a portion thereof) and now supposed to loan money to state for dental work, if one has the funds. Concern here is will state payback since there are no appropriations.
- Central_IL - Tuesday, Mar 7, 17 @ 1:17 pm:
I’m surprised any dentists will wait to be reimbursed by the state. I’m still waiting on reimbursement from my son’s wisdom tooth extraction from March of 2015.
- Anon - Tuesday, Mar 7, 17 @ 1:26 pm:
It’s not a money grab when there are many dental offices in Illinois that are owed hundreds of thousands of dollars for dental work that they have completed in good faith to their patients rather than not seeing State Employees. In other words, dentists are doing the right thing, even though they could turn their back.
- HangingOn - Tuesday, Mar 7, 17 @ 1:55 pm:
==which costs $75-$125? Why would that be?==
I had $9 left from my last paycheck after paying mortgage, groceries, electric, etc. My last check was $1208 after pension, health insurance, and everything else was taken out. I would be one who can’t afford $75 - $125.
- scott aster - Tuesday, Mar 7, 17 @ 2:39 pm:
welll in Chicago many ask for a credit card at time of service…..it has just become routine. We are waiting for payment from 2015….Delta dental only pays the retirie not the dentist.
- No Raise - Tuesday, Mar 7, 17 @ 3:57 pm:
Recommend obtaining the negotiated contract rate or EOB from dental insurance company and then paying bill. Do not pay non-contracted bill if you are using PPO provider, which you should be. And if you pay bill, you will at least get the Prompt Payment Act interest.
- Arthur Andersen - Tuesday, Mar 7, 17 @ 6:21 pm:
Springfield isn’t loaded with oral surgeons. I have two kids’ sets of wisdom teeth ready to come out. This office, one of the majors in town, is 100% cash on the barrelhead, take it or leave it. So AA lays out around $5 grand and gets $1800 back in a year and a half. The interest ain’t exactly compelling when you get that kind of haircut.
- 37B - Tuesday, Mar 7, 17 @ 7:55 pm:
Still maintaining a 50% bounce rate. This one puzzles me.
- Chops - Wednesday, Mar 8, 17 @ 8:19 am:
This bill needs to pass.
As a dentist in Springfield, the budget debacle has been a nightmare. 40% of our patients are state workers. The current amount owed to our office is now well over $600,000. We have been unable to fully fund our employees’ retirement or offer much deserved salary increases. We haven’t been able to invest in improvements to our office or to update our technology. We’ve been in a constant state of limbo for nearly 2 years.
For those of you saying this is a money grab by dentists, I’d like to know how they’d feel if they provided a service to someone and then had to wait 18 months before ever seeing any payment for that service. Dental practices should not be expected to act as banks for the state of Illinois.