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Today’s number: $3.34 billion with no end in sight

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Illinois

* From the Commission on Government Forecasting and Accountability…

Over the past fiscal year, the lack of an enacted budget has resulted in the State Employee Group Insurance Program (SEGIP) building up a large backlog of unpaid claims. As of the end of June, approximately $3.34 billion in claims were being held by the state from various insurers, organizations, and companies.

Of this total, the largest portion was approximately $1.6 billion of HMO/Medicare Advantage claims. The second largest portion, Open Access Plans, totaled $741.2 million. The third largest portion of the overall claims hold came from CIGNA, which had $556 million in claims currently held by the state.

Concurrently, the estimated time for claims to be held was 314-557 days for Managed Care, 477-547 days for Open Access Plans, and 497-574 days for CIGNA. […]

Despite a stop-gap budget being passed, however, claims will continue to build up and estimated claims hold times will increase due to no appropriation for Group Insurance.

Ugh.

posted by Rich Miller
Thursday, Aug 4, 16 @ 11:22 am

Comments

Still waiting to see how much it cost to bring my daughter in to the world 13 months ago…Do i need to keep $3000 in my savings? Or $1500? I’m sure the economy doesn’t need that money circulating through it. I’ll just park it right here til the state gets itself figured out

Comment by JohnnyPyleDriver Thursday, Aug 4, 16 @ 11:25 am
What a way to run a railroad. And my friends wondered why I switched to the Teamsters health plan.

Comment by Huh? Thursday, Aug 4, 16 @ 11:27 am
Rauner is just waiting for the right moment to launch his Illinois revival.

In the meantime, he’d appreciate it if you just (a) keep any negative thoughts and comments to yourself and (b) hang in there.

He’s still tweaking the messaging mechanisms in preparation for the revival.

Comment by Formerly Known as Frenchie M Thursday, Aug 4, 16 @ 11:29 am
Don’t worry, the “Turnaround Agenda” will likely generate a few bucks to buy Rauner a fiddle to play while Illinois burns!

Comment by Anonymous Thursday, Aug 4, 16 @ 11:30 am
How much interest will be paid to the vendors? The State’s credit card bill continues to spiral out of control!

Comment by Johnnie C. Retired State Employee Thursday, Aug 4, 16 @ 11:32 am
Meanwhile, how much longer can we expect venders to keep carving butter into cows and surgeons to keep sculpting surgeries? When will the jig be up?

Comment by Dome Gnome Thursday, Aug 4, 16 @ 11:37 am
I do not understand why these health plans have not sued. What are they waiting for?

Comment by Pawn Thursday, Aug 4, 16 @ 11:39 am
Sad. I’d like to blame Rauner, but shorting the group health approp has been one of the few bipartisan practices.

Comment by Norseman Thursday, Aug 4, 16 @ 11:45 am
My family had to deal with a crisis situation related to this earlier this week under the CIGNA plan. To stay out of the hospital (or worse), a family member requires monthly treatments that nominally cost $12,000 per treatment (a bit less under group insurance rates). A late treatment can make on-going treatment permanently ineffective. We received notice that our provider would no longer accept our Cigna coverage, since they hadn’t been paid in over two years. This notice came with only 2 business days left before the next scheduled treatment. With a potential annual out-of-pocket cost of up to $144,000 dollars hanging over us, we had to scramble to transfer the treatment to another provider that still accepts CIGNA from state employees/retirees.

We did get the transfer done, but this could easily happen again as the impasse drags on. I want to be clear that this is not CIGNA’s fault; they’re just the plan administrator. It’s about the state not paying any claims, even as they continue to deduct the employee share from pay and pension checks. In fact, CIGNA’s customer service and medical authorization staff went above and beyond the call in expediting the transfer. I couldn’t be happier with them and the service I received.

Comment by X-prof Thursday, Aug 4, 16 @ 11:47 am
I wonder how many physicians will require patients to pay out of their own pocket and then wait to be reimbursed when the state pays up?

Comment by Stones Thursday, Aug 4, 16 @ 11:48 am
Wasn’t the Stop Gap budget underfunded also?
Health plans haven’t sued because of the 12% interest after the debt is 90 day old.

Comment by WhoKnew Thursday, Aug 4, 16 @ 11:52 am
I thought the state had to pay the Medicare Advantage premiums and that United Healthcare had to pay the claims. What gives?

Comment by kimocat Thursday, Aug 4, 16 @ 11:53 am
A de facto way to eliminate health insurance for public employees and qualified retirees is to stop paying for it. When the backlog gets big enough, the pols will throw up their hands — the way they did with the pension liability — and saw “we can’t afford it.

Comment by anon Thursday, Aug 4, 16 @ 12:03 pm
There should be legislation that provides a mechanism for passing that 12% interest to the patient when providers insist that the patient pay up front. This is only a partial solution, because it does not help people that don’t have the resources to make the up-front payments. Still, why should the state protect the providers and not patients?

Comment by X-prof Thursday, Aug 4, 16 @ 12:03 pm
To put the impact of the Group Health backlog in perspective, consider the history of unpaid bills in the last fiscal year (Comptroller’s Fiscal Focus 7/8/16). At the beginning of FY 16 the backlog was $4.05 B and at the end of the fiscal year it was $7.62 B. That’s an increase of $3.57 B over the course of the year with the impasse. The $3.34 B of Group Health that is backlogged in FY 16 is essentially equal to the increase in backlogged bills the last fiscal year. If that’s being counted in the Comptroller’s backlog, then Group Health would appear to be the major driver of the increased backlog during the impasse.

Comment by muon Thursday, Aug 4, 16 @ 12:09 pm
I wish I had the wherewithal to sue over my 18 month old Dental bills. Its a minor thing in the grand scheme, but I think it qualifies as a de facto unconstitutional diminishment.
-X-Prof _. I’m pretty sure I get the interest already ??? My dentist has always required up front payment.

Comment by Anotherretiree Thursday, Aug 4, 16 @ 12:10 pm
This is nothing new, it has gone on for a decade or longer. It is hard to get your brain around how irresponsible this practice is. I once described it as “negative reserves!” I blame it on the providers (hospitals, doctors, BCBS of Illinois, United Healthcare, etc.) who could put a stop to this if they wanted to. But they would rather not rock the boat. Plus the overdue claims are considered good as gold assets on their balance sheets, because they will eventually get paid with interest. But as more and more providers refuse to wait to get paid, it is the employees and retirees who suffer!

Comment by formerpro Thursday, Aug 4, 16 @ 12:16 pm
anon – There are civil suits pending against the state for not paying claims, presumably for breach of contract. Does anyone know the current status of those cases? Since health insurance is part of the terms of employment, I don’t see how the state would not be forced to pay no matter what the pols do with their hands. The courts are forcing the state to pay promised pension benefits. They’re just not stipulating how to fund those payments and how to pay down the pension liability.

Comment by X-prof Thursday, Aug 4, 16 @ 12:17 pm
Perhaps now that state employees and retirees are having to pay more and more out of pocket because the state is refusing to pay, it is time for a new lawsuit brought by state employees and retirees against the state. The ISC has been clear that when the state does not meet its constitutional obligation (defaults or nearly defaults) there is reason to court mandated relief. This should probably come from retirees as the group that is clearly having their constitutionally protected rights being violated by the status quo. Employees rights are being violated since they are charged for insurance that may now be worthless.

Comment by ex-ISU Thursday, Aug 4, 16 @ 12:17 pm
–x-prof

You beat me to the idea, and I had forgotten the details on the case that you referred to.

Comment by ex-ISU Thursday, Aug 4, 16 @ 12:18 pm
Anotherretiree – If your dentist gives you 12% interest, that’s voluntary. As I understand things, there’s nothing in state law that requires this.

I’m fortunate enough to have some reserves. If I could receive a guaranteed return of 12% I would consider transferring funds from retirement investments to get it. There is some added risk, however, because there’s no guarantee when the state will pay up. The way things are going, I might not live that long.

Comment by X-prof Thursday, Aug 4, 16 @ 12:25 pm
-X-Prof No, I meant when the check arrives from the Comptroller to me, it has interest already. Pretty sure I’ve always gotten the interest.

Comment by Anotheretiree Thursday, Aug 4, 16 @ 12:28 pm
So if the cause is no appropriations, does that mean there have been no appropriations for two years? That puts us in Quinn’s term. And more importantly, WHY have there been no appropriations?

Comment by Anonymous Thursday, Aug 4, 16 @ 12:28 pm
ex-ISU: CapFax comes through: https://capitolfax.com/2016/04/14/lawsuit-filed-over-state-health-insurance/

I can’t find any updates in the media since the case was filed in April.

Comment by X-prof Thursday, Aug 4, 16 @ 12:39 pm
I just have one question. Why can’t the retired people get a class action going? I am being refused treatment because they aren’t paying. This is no different than the pension cut or trying to make us pay a health insurance prenuin. My benefits are being cut.

Comment by Rick Thursday, Aug 4, 16 @ 12:44 pm
== So if the cause is no appropriations, does that mean there have been no appropriations for two years? That puts us in Quinn’s term. And more importantly, WHY have there been no appropriations? ==

For probably 3 or more decades, the State has consistently underfunded the employee health insurance line item(s) in the budget. Just like pension funding, insurance funding was it to pay for other things and to avoid a tax increase.

Given that underfunding, the backlog has grown from a few months behind to one to two years behind. Any current year appropriation is just paying last year’s bills. To get “current”, the State would need to double their appropriation for a couple of years, not drastically cut it like proposed by Rauner.

Comment by RNUG Thursday, Aug 4, 16 @ 12:59 pm
Anotheretiree –– I don’t think it works like that with my dentist. I don’t recall ever receiving a check from the comptroller for dental or medical, but would have to check. From what I’ve read, there’s no state law that requires the interest to go to the patient.

Anonymous – I can’t vouch for the accuracy of the provider’s 2-year claim of non-payment. Claims should have been paid, although quite late, for the last fiscal year under Quinn. Payments stopped with claims filed under the first fiscal year under Rauner with no budget agreement.

Sometimes I see the late-payment interest rate listed as 9%, sometimes 12%. Which is accurate?

I have an appointment and have to drop out here for awhile.

Comment by X-prof Thursday, Aug 4, 16 @ 12:59 pm
-Rick- Because it takes millions of dollars. The Kanerva case was unique in that the escrowed health care premiums represented a pile of money for lawyers fees. The State has indemnified itself so it isn’t responsible for fees when it looses. Got a few million to spare ??
-X-Prof. If you are paying your Dentist up front, and then the Dentist sends you a check some year down the road, then it sounds like he is pocketing the interest ! A little unethical.
I pay up front. They turn it in to Delta with instructions to pay patient.

Comment by Anothereetiree Thursday, Aug 4, 16 @ 1:33 pm
The website says CIgna contracted health providers are currently being paid for claims processed early Feb 2015, all others early Dec 2014. Read it and weep.

Comment by Thoughts Matter Thursday, Aug 4, 16 @ 1:47 pm
I was wondering if a class action could get going wouldn’t the law firm firm get a cut of the money they are suppose to be sending in to the company’s managing this insurance. I live out of state. M.D.s don’t care what is going on in Illinois. I have had to pay my last two medical treatments myself. They where small under $1000. I can handle those. I had to go to an E.R. My neighbor said my bill will be around $7,000 for that. That’s a hardship to pay. What if I need open heart at say $250,000. No way can I pay that.
Should I move back to Illinois and live under a blue tarp at the capital steps? Why should we have to be on hospital payment plans? Like I said this not paying for year and a half is cutting my benefits.

Comment by Rick Thursday, Aug 4, 16 @ 1:48 pm
== Sometimes I see the late-payment interest rate listed as 9%, sometimes 12%. Which is accurate? ==

0% interest for the first 90 days, 1% interest per month thereafter.

So 9% annual the first year, 12% annual after first year.

Comment by RNUG Thursday, Aug 4, 16 @ 1:56 pm
X-prof: You can check the status of the class action lawsuit here:
https://w3.courtlink.lexisnexis.com/cookcounty/FindDock.asp?NCase=2016-CH-05194&SearchType=0&Database=3&case_no=&PLtype=1&sname=&CDate=

The next court date is August 11, if I’m reading that correctly.

Comment by Anon236 Thursday, Aug 4, 16 @ 1:58 pm
== I can’t vouch for the accuracy of the provider’s 2-year claim of non-payment. Claims should have been paid, although quite late, for the last fiscal year under Quinn. Payments stopped with claims filed under the first fiscal year under Rauner with no budget agreement. ==

From personal experience with my mom’s estate, as of early to mid 2015, CIGNA aka State Quality Care was averaging about 14 months behind on her bills, with one that was about 18 months.

Comment by RNUG Thursday, Aug 4, 16 @ 2:02 pm
== . The Kanerva case was unique in that the escrowed health care premiums represented a pile of money for lawyers fees. ==

And the only reason that money ended up escrowed is because the attorneys for the group of retirees headed by Ralph Kanerva asked for it to be escrowed; none of the other groups / attorneys did.

Comment by RNUG Thursday, Aug 4, 16 @ 2:11 pm
== The State has indemnified itself so it isn’t responsible for fees when it loses. ==

Changing that law should be a Turnaround Agenda; I could support that item.

Comment by RNUG Thursday, Aug 4, 16 @ 2:14 pm
I was gone for a while so this is a bit late, but Delta Dental sent me checks for interest when they were late with reimbursements in 2013-2014 time period.

Comment by ex-ISU Thursday, Aug 4, 16 @ 3:57 pm
Man would private sector folks be screaming if their company didn’t pay their insurance provider. But I guess its okay to do that to public servants and their families. That’s why the private sector is hypocritical.

Comment by Honeybear Thursday, Aug 4, 16 @ 4:40 pm
I have a hospital bill from November 2014 that has not been paid by CIGNA.

Comment by RDB Thursday, Aug 4, 16 @ 7:09 pm