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Springfield Clinic to begin billing patients their share before collecting from the state

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Illinois

* This seems like a reasonable move by the clinic, considering the position it’s been put in by this impasse…

Several thousand Springfield Clinic patients who are insured through the state’s health plans will be asked to pay hundreds of dollars in co-payments, deductibles and other out-of-pocket costs that the clinic hadn’t tried to collect the past 1½ years.

The clinic normally waits to bill patients their share of the total cost after it receives payment for the majority of the cost from the State Employee Group Insurance Program.

But with payments for certain plans at a virtual standstill during the ongoing state budget crisis, and with Springfield Clinic owed a $68 million, the clinic has decided to ask patients to pay their share of bills regardless of whether the state’s share has been paid.

The clinic’s requests for payment will apply to medical services provided from this point forward, as well as for Springfield Clinic claims that have remained unpaid by the state for the past 12 to 18 months, according to a letter the clinic sent to about 5,000 patients last week.

posted by Rich Miller
Tuesday, Oct 18, 16 @ 9:17 am

Comments

“I’m focused on Illinois,” Rauner said.

Take him at his word. See the results of his “focus.”

Comment by wordslinger Tuesday, Oct 18, 16 @ 9:22 am
This is money that they would be paying anyway, right? If so, I don’t see any thing newsworthy here. Lots of harm being done in lots of other areas but not here.

Comment by Anonymous Tuesday, Oct 18, 16 @ 9:27 am
They should consider themselves lucky. I have a doctor and dentist that make me pay up front the state’s share of the costs too. And I have to argue them down from the rack rate charge to what they would have accepted from the our insurance company. Some “Cadillac” plan, right?

Comment by kimocat Tuesday, Oct 18, 16 @ 9:27 am
Increasing the immediate out of pocket costs of seeing a physician makes seeking treatment less likely which could result in higher long term healthcare problems for state employees.

That’s exciting.

Comment by Anon Tuesday, Oct 18, 16 @ 9:29 am
Faculty at SIUE are about to raid Springfield with torches and pitchforks as providers down there are starting to turn them all away if they have Healthlink through the state.

Comment by Anonymous Tuesday, Oct 18, 16 @ 9:31 am
===This is money that they would be paying anyway, right? If so, I don’t see any thing newsworthy here. Lots of harm being done in lots of other areas but not here.===

That really depends. Once the bill is submitted to insurance a lot of different things can wind up happening that reduce the total cost or partial cost.

Springfield Clinic will basically just be guessing what part would be uncovered.

Comment by Anon Tuesday, Oct 18, 16 @ 9:31 am
Vote accordingly. In Sprlngfield, that means sending Rauner appointee, Jimenez, back to the First Lady.

Comment by Norseman Tuesday, Oct 18, 16 @ 9:32 am
This practice isn’t simply limited to people with state insurance. It’s becoming more standard generally.

Comment by A guy Tuesday, Oct 18, 16 @ 9:32 am
I paid my dentist in full in May 2015 and still have not received payment from Delta. That’s one and a half years! I’m still waiting for about $500. Now I’m making my dentist to wait for payment, as I make small monthly payments to cover my share. I hope he’ll let me continue, as it’s tough to budget on a retired income for these expenses. Too bad the Governor doesn’t have to budget the way we do.

Comment by Gone, but not forgotten Tuesday, Oct 18, 16 @ 9:38 am
This is already and will increasingly cause a lot of financial hardship for state employees, union and non-union. If it doesn’t get fixed and soon, people will leave.

Comment by Ron Burgundy Tuesday, Oct 18, 16 @ 9:41 am
-A guy @ 9:32 am: To that I say “thank you Obama”.

Comment by Gone, but not forgotten Tuesday, Oct 18, 16 @ 9:43 am
The furor over this is a bit silly. Do people who work for the state realize that most people with insurance are often required to pay their copayments and deductibles either at the time of service or within a week or so of being billed? Growing up my parents always had to shell out a copay when I visited the doctor or a specialist (unless it was an ER visit or something completely covered like a dental cleaning). That is how the system is supposed to work. If you owe a deductible then you need to pay it. If you owe a copay then you need to pay it. Instead of being “surprised” - even when you know you owe the money - offer to make the copay on the spot. Use a flexible spending card if you have it. This is not rocket science.

Comment by Team Sleep Tuesday, Oct 18, 16 @ 9:45 am
If Springfield Clinic wasn’t collecting copays at the time of service, that’s just bad business practice.

One of my doctors makes me pay everything up front, but I consider it a safe investment at a good rate of return since I receive the 9% the state pays in penalty for the late payments.

Comment by RIJ Tuesday, Oct 18, 16 @ 9:51 am
Better fire up the Vendor Assistance welcome wagon and send them over to the Clinic we doubt the work force will want to ante up upfront which means the clinic will look like GhostTown USA. And while the workforce is at it they can toss their appointed lawmakers.

Comment by Annonin' Tuesday, Oct 18, 16 @ 9:52 am
== Springfield Clinic will basically just be guessing what part would be uncovered. ==

==

Comment by RNUG Tuesday, Oct 18, 16 @ 9:53 am
Team Sleep, please don’t generalize. This is one clinic located in Springfield that has bad business practices. Believe me, elsewhere we pay our copays, deductibles, and sometimes the entire bill. If the State were functioning properly, it would pay the bills on time, and this would never have happened. Don’t ignore the real cause of this situation.

Comment by RIJ Tuesday, Oct 18, 16 @ 9:55 am
Team Sleep I completely agree, I am a state employee and always pay my deductible at time of service. What I find abhorrent is the fact my son has lost two pediatricians because of the slow/non-payment by the state. I have run out of options since no doctor in my area will take state employees. I have hundreds of dollars coming out of may paycheck every pay for insurance that is unusable. Normally when people pay for a service they expect something in return and when that does not happen it is called fraud. This fraud is being perpetrated on both the medical professionals and policy holders by the State of Illinois.

Comment by Madison County Mad Tuesday, Oct 18, 16 @ 9:57 am
== If Springfield Clinic wasn’t collecting copays at the time of service, that’s just bad business practice. ==

== Springfield Clinic will basically just be guessing what part would be uncovered. ==

==Springfield Clinic will basically just be guessing what part would be uncovered. ==

In my experiences, Springfield Clinic does collect the specified co-pay up front. And from dealing with the various insurance companies and the State all these years, they are real good at their estimates of what will and will not be paid. Most of the time they are dead on; sometimes they are a few dollars off.

Plus this only affects the state employees / retirees who are not on an HMO or Medicare, which in the overall scheme is a relatively small number.

Comment by RNUG Tuesday, Oct 18, 16 @ 9:59 am
Things we are already seeing.
1) An increase in job postings for work with the state. Especially the “meat grinder” positions like, nursing, corrections, Child protection specialist, child welfare specialist, are open. Actual positions you never see are open all over the state. Which is actually a bad thing because the experienced workers will move up into an unfamiliar position. But so much is open for certified workers.
2) Huge mass retirements. We had two already this month. This office is clearing out.
3) Decline in government function. We literally have whole programs we are no longer doing and policy that we can’t enforce anymore. Something has to give. We can only do so much.

Changes about to happen.
1) State workers leaving state service and moving to different locations to get jobs. Springfield will empty.
2) Labor unrest with the Nov 15 ILRB decision. It’s either face layoffs if the ILRB accepts the ALJ recommendation. OR ILRB declares impasse and AFSCME is forced to eat the new contract. This will greatly accelerate the collapse of the workforce.
3) Then add to that the increased medical bills from medical providers, doubling of health insurance, and associated costs and you might have the state government collapsing due to lack of workers.

Look you don’t have to listen to my warning. But I don’t think Rauner really believes that the workforce will collapse. Government is totally different than the private sector. You can say it’s not but you would be a fool. Those who have not worked for State government cannot assess or judge. Just like I can’t say diddly really about what law enforcement goes through. I don’t know. I’ve been in the military but that’s different. Being in the private sector is totally different from the public sector.

Loving God would some independent journalist find out how small our workforce has gotten and verify it. Spend the time to verify it. Don’t just accept a number from CMS. No Raunerite can be trusted to tell the truth.

Verify and you’ll confirm what I am seeing with my own eyes, what I know to be true.

Comment by Honeybear Tuesday, Oct 18, 16 @ 10:02 am
Springfield Clinic collects the co-pay at the time of service. I paid a co-pay for a specialist in April 2015 that I didn’t owe because of the reason I was there. I’m still waiting for them to get the actual info from the insurance so they know that money can be applied to some other amount I might owe. That’s 18 months and the state hasn’t paid that bill yet.
If they aren’t going to start paying why do we continue to have the premiums held out of our checks. I pay more in premium than I owe the Clinic. I’d like to have that money to use for that until the state sees fit to start paying again.
The part the clinic won’t know about is if you have a deductible that needs to be satisfied first on top of your co-pay.
If this was a private entity that wasn’t paying the bills, someone would be in court

Comment by ANONIME Tuesday, Oct 18, 16 @ 10:06 am
Things are tough all over, right? I guess we all need to suck it up, buttercup.

As a self-employed American-capitalist-entrepreneur, I am looking forward to finding out what my new premiums will be for the coming year.

We currently pay $800 per month ($9600 yr), for a $6500 deductible silver plan, for two people in their 50’s. We get 2 PCP visits per year without having to meet the deductible, and prescription tier prices without meeting the deductible.

If plan offerings go up 50% as foretold, we will be looking at $1200 mo, or $14,400 yr. (I can’t breathe as I type that.)

That is too much money being sucked out of this economy by the now consolidated top three health insurance companies.

REPEAL and REPLACE. please and thank you.

I sure hope state employees don’t think they deserve sympathy on this development with Springfield Clinic.

Comment by cdog Tuesday, Oct 18, 16 @ 10:12 am
” If you owe a copay then you need to pay it…. Use a flexible spending card if you have it.”

What is the matter with you? Everyone *has* to pay the co-pay up front when seeing a Springfield Clinic doctor. The story is about patients being billed for what the state insurance program normally covers.

Second, an entire year’s worth of flex spending funds could easily be eaten up by the cost of one doctor’s visit. How bloody clueless does a person have to be to make comments like this? This is a life-or-death situation for many people: diabetics, cancer survivors, any one else with any other kind of chronic ailment. Would you be happy if state employees just died? Unbelievable.

Comment by Nick Name Tuesday, Oct 18, 16 @ 10:13 am
==In my experiences, Springfield Clinic does collect the specified co-pay up front. And from dealing with the various insurance companies and the State all these years, they are real good at their estimates of what will and will not be paid. Most of the time they are dead on; sometimes they are a few dollars off.==

That’s my experience as well. Recently they sent me a bill for $5 because they undercharged me for my copay at my last visit. I gladly paid it.

Comment by IllinoisBoi Tuesday, Oct 18, 16 @ 10:15 am
Springfield residents who live in the 99th District: Vote. Accordingly. Send Jiminez packing. And Munger too.

Comment by Nick Name Tuesday, Oct 18, 16 @ 10:18 am
Deductibles and co-pays aren’t the real issue right now. It’s the people being turned away because of this backlog, and the threat that providers will start making them cover the state’s share for 18 months plus. Not a good time to have any major surgery if you are a state employee. Stay healthy, friends.

Comment by Ron Burgundy Tuesday, Oct 18, 16 @ 10:22 am
==Government is totally different than the private sector.==

You can say that again.

Comment by Responsa Tuesday, Oct 18, 16 @ 10:22 am
RNUG, it’s not that bad. They get the same EOBs that the employee/retiree does. I’m pretty sure that’s what they use now to bill the employee/retiree.
There’s a fair amount of left pocket/right pocket with SC and Health Allliance that helps the Clinic weather these storms as well.

Oh, Annonin’ you’ll be pleased to know that Health Alliance is a big customer for the Vendor Assistance Program.

Comment by Arthur Andersen Tuesday, Oct 18, 16 @ 10:26 am
There seems to be a lot of confusion here. 1. If the state paid bills on time we (state employees) would have had to pay these co-pays months or years ago.
2. They are mainly talking about co-pays for services aside from typical doctor visits (ambulatory surgery, labor and delivery, etc.).
3. They are not just “guessing” you will notice that you typically get your EOB from the insurance company within a few weeks of the service. This EOB tells the provider what they can expect.

Comment by Mr. Appropriated Tuesday, Oct 18, 16 @ 10:29 am
Mad Co - that stinks and is certainly a problem. In areas like Springfield providers have no choice. Outside of Sangamon County, though, state workers are fewer and farther between so that issue is worse.

Nick - stop being so dramatic. This is part of the problem with state workers screaming bloody murder about everything. Everything is always a problem and everything is always the end of times. You can load your FSA card with $2,400 a year (which is the max amount allowed by the ACA but that is another story for another day). I have had state insurance for 10+ years and several providers have let copayments and deductibles slide. In my personal experience Springfield Clinic is one of the worst offenders and their customer service is about as bad as AT&T or Comcast. Also, by law and by AG enforcement, providers cannot bully patients/clients into paying everything at once (especially if the provider is a non profit like the HSHS system). You can set up payment plans and the state will reimburse you for these payments. Is it ideal? No. But that is the situation.

And what is Tony D going to do? Wave a magic wand and make everything better? Vendors everywhere are waiting for payments. Yesterday’s story about mass transit is Example #1 of that.

Comment by Team Sleep Tuesday, Oct 18, 16 @ 11:01 am
Springfield clinic already collects copays at the time of service for the most part. The strange part is when the provider bills an amount much higher than the state contract allows.

Comment by Liberty Tuesday, Oct 18, 16 @ 11:37 am
Apria turned me over to a collection agency the same day I got my EOB from HL 20 months after the service.

Comment by Retired Tuesday, Oct 18, 16 @ 12:06 pm
““I’m focused on Illinois,” Rauner said.”

We need to unfocus Rauner’s destruction of IL in 2018.

Comment by Anonymous Tuesday, Oct 18, 16 @ 12:49 pm
I understand why Springfield Clinic has to charge us our portion of the bill, and I don’t mind paying my part as long as I can make payments on what I owe. However, I do expect my insurance company to pay their part as well.

Comment by Mama retired Tuesday, Oct 18, 16 @ 12:56 pm
I wonder how many providers pass the interest on to the person who had to pay upfront.

Critics holler state employees get better benefits while
8.1% of CMS group insurance costs are interest.

page 15, Chart 5
http://cgfa.ilga.gov/Upload/FY2017GroupInsuranceReport.pdf

Comment by Liberty Tuesday, Oct 18, 16 @ 1:00 pm
- Honeybear - Tuesday, Oct 18, 16 @ 10:02 am: =

You are correct with the exception of Rauner caring about the workforce collapsing. He wants the unionized workforce to collapse - -it is his goal. He is doing it slowing thinking the public won’t notice.

Comment by Mama retired Tuesday, Oct 18, 16 @ 1:10 pm
- RNUG - Tuesday, Oct 18, 16 @ 9:59 am: - “Plus this only affects the state employees / retirees who are not on an HMO or Medicare, which in the overall scheme is a relatively small number.” -

RNUG, Are you sure this does not affect people on Medicare Advantage? What about people on Medicare with State Insurance as a supplement?

Comment by Anonymous Tuesday, Oct 18, 16 @ 1:16 pm
- Honeybear - Tuesday, Oct 18, 16 @ 10:02 am:-

Rauner does not care that the workforce is collapsing, or that you doing the work of 3 people. As you well know, Rauner wants the union workforce to collapse, and hire Republicans as independent contractors to take over the union jobs.

Comment by Anonymous Tuesday, Oct 18, 16 @ 1:22 pm
–and hire Republicans as independent contractors to take over the union jobs.–

No, hire contractors at twice the expense. Republicans won’t work for the state. There’s another tasty bit. CMS, how many superstars have come on board in the last 3 months? I bet only a handful. No up and coming person would dream of dooming their career with state service.

Comment by Honeybear Tuesday, Oct 18, 16 @ 1:54 pm
–No up and coming person would dream of dooming their career with state service.–

Guess we won’t be needing that revolving door provision anymore since those folks are doomed.

Comment by Ron Burgundy Tuesday, Oct 18, 16 @ 2:14 pm
== RNUG, Are you sure this does not affect people on Medicare Advantage? What about people on Medicare with State Insurance as a supplement? ==

It didn’t read like it did. Mrs RNUG is on original Medicare with Health Alliance secondary. She just got a notice she has met her deductible for the year. She has an upcoming appointment; I’ll let you know for sure in a few days.

Comment by RNUG Tuesday, Oct 18, 16 @ 3:03 pm
@11:01
For the last few years, if we pay my Springfield dentist immediately, they will give us a 5% discount off the negotiated (with the state) amount normally submitted to the dental plan, and submit the claim for us. Lately, we’ve been waiting just over a year for the reimbursement (less any deductible/copay), but we do get that nice interest check at a rate I haven’t seen at the bank since the 80s. Fortunately, we can afford to float the state’s obligations, but I’m sure this is a real burden for many.

Now, with Springfield Clinic, we pay our appropriate copay at the time of service. I will say that I have little faith in their accounting system, because _sometimes_ they say a copay isn’t due, then later we get a bill, and other times, we’ll get a refund check for a copay we made earlier. Either way, the invoice numbers received at the time of service _NEVER_ match the invoice numbers on a later statement for the same services. We even once went into their accounting office to reconcile this situation for MCAP/flexible spending purposes, and we left thoroughly dissatisfied with their utter inability to provide a meaningful reconciliation or explanation of copays charged or refunded.

Comment by Hieronymus Tuesday, Oct 18, 16 @ 3:19 pm
Hey- for what it’s worth- for years several of our doctors when we are at their offices access our insurers electronically compute the reimbursement then have us pay the co- pays and out of pocket balances on the date of service. I don’t blame the providers- they shouldn’t have to wait for the insurance payments so they at least should receive the patient portion when they provide the service

Comment by Sue Tuesday, Oct 18, 16 @ 3:31 pm
Honey- Bear- why don’t you take President Obama’s advice and stop your incessant whining

Comment by Sue Tuesday, Oct 18, 16 @ 3:34 pm
“Republicans won’t work for the state.”

Honeybear, I know its hard to believe, but there are a lot of Republicans who work for the state.

Comment by Mama Retired Tuesday, Oct 18, 16 @ 6:29 pm
I pay my co-pay at time of service if anyone is ready to collect it. Sometimes they aren’t (credit card machine closed out already, lines down, etc). Most Springfield Clinic services don’t have deductibles beyond that for me as they are a Tier I provider in Healthlink.

One of the problems is that Healthlink quit mailing EOBs, and they are only available online for 12 months. Since the state is 18 months behind - I have no way of going back and seeing what any deductible MIGHT be to any provider. I can call Healthlink if I remember the date of service.

As for the flex benefits, they expire every June 30, and you only have a 3 month grace period to turn in bills or EOBS. Which you don’t have, because again the state is 18 months behind.

I got a bill this week for 182 dollars for durable equipment (CPAP mask, hose, etc) for my spouse. It was 19 months ago. Too late to use flex benefits for that period. We’ve slept since then, never got a bill, forgot it was even outstanding.

Comment by thoughts matter Tuesday, Oct 18, 16 @ 8:08 pm