Capitol Fax.com - Your Illinois News Radar

Some state health insurance claims take 675 days to be paid

Posted in:

Illinois

* From COGFA…

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 December, approximately $3.91 billion in SEGIP claims were being held by the state from various insurers, organizations, and companies. Of this total, the largest portion was approximately $1.99 billion of HMO/Medicare Advantage claims. The second largest portion, Open Access Plans, totaled $743 million. The third largest portion of the overall claims hold came from CIGNA, which had $605 million in claims currently held by the state.

Concurrently, the estimated time for claims to be held was 303-675 days for Managed Care/Medicare Advantage, 468- 524 days for Open Access Plans, and 398- 608 days for CIGNA… Without additional funding, claims will continue to build up and estimated claims hold times will increase due to no appropriation for Group Insurance.

* Comptroller Susana Mendoza addressed this backlog issue during an interview with Jordan Abudayyeh. Mendoza read a letter from an SIU professor who was denied a doctor’s appointment in St. Louis because the state isn’t paying its health insurance bills…

“They say they are no longer seeing people with state of Illinois insurance because it does not pay out. Some of my colleagues have faced similar issue[s] very recently. It’s highly problematic. Everyone here goes into St. Louis to treat more serious health issues. I’m incredibly angry. This is illegal and unethical. We are all paying for services not being given. As politicians play political games, now our health and lives are on the line. We think you should know,” the Comptroller read.

Mendoza says she has to make decisions everyday on who gets paid when, juggling the needs of people around the state.

“I still feel that anybody who can go to bed at night knowing that this is happening and is just going to hold off for whatever their pet projects are, is just somebody who is disconnected from reality. And it’s not a political thing, this is a reality and I’m a person who’s in a position to see the consequences [of] this inaction at play,” said Mendoza. “So, yes, I am upset. I’m justifiably upset. People should be worried if I’m not upset and I want to make things better. I would like the Governor to do his job and actually govern, to lead, to not put blame on everybody else, to not just if you disagree with him, oh then you know, you must be speaking on behalf of some other democratic leader. That’s nonsense. I speak for myself. So do so many other Illinois residents who are yelling and feel that they’re not being heard. I’m at least trying to listen to folks. And I want to be their voice at a time where we’re faced with our worst fiscal crisis. And you know, you haven’t heard the comptroller speaking on behalf of other people, until I got here. But I’m really sick and tired of hearing all of these people complaining because they’re hurting and they’re suffering, and [if] somebody is going to speak out it’s going to be me,” Mendoza said.

Governor Rauner’s spokesperson, Catherine Kelly, sent the following statement in response to Comptroller Mendoza.

“Comptroller Mendoza spent 10 years in the General Assembly voting for the very unbalanced budgets, pension holidays and borrowing that have led to our staggering financial challenges. Instead of playing politics as usual, it would be helpful if she joined in a constructive conversation about balancing our budget and growing our economy. In the meantime, we ask that she stand with the Governor in opposing the Attorney General’s efforts to stop state employees from being paid.”

I recently received a similar letter from an SIU professor, by the way.

posted by Rich Miller
Friday, Feb 3, 17 @ 9:47 am

Comments

Is this true, Ms Mendoza, as she claims?

Comment by Anonymous Friday, Feb 3, 17 @ 9:52 am
To “ck”

===…”…Instead of playing politics as usual, it would be helpful if she joined in a constructive conversation about balancing our budget and growing our economy. In the meantime, we ask that she stand with the Governor in opposing the Attorney General’s efforts to stop state employees from being paid.”===

“…constructive conversation about balancing our budget and growing our economy.”

This is “ck” cranking up that ole Rauner Word Jumble, saying nothing but attaching her own name to something so ridiculous based on no ROI of what these growing the economy things are. The thoughtless quote that is a staple of just regurgitating nothingness.

“In the meantime, we ask that she stand with the Governor in opposing the Attorney General’s efforts to stop state employees from being paid.”

So, the spokesperson for the governor feels that having no budget but paying state workers is important?

Speaks volumes to really understanding that whole governing/budget thingy.

I’m reminded “ck” was a producer/reporter. I hear Mizzou is a “pretty good” journalism school. Wonder how the reporter/producer would look at this silliness and not roll their eyes or even giggle.

When others trade of your personal credibility, it’s you that lose out, never them.

“Thanks!”

ow

Comment by Oswego Willy Friday, Feb 3, 17 @ 9:54 am
CK’s microphone cut out at the very end.

“…stop state employees from being paid…
without a budget.

Comment by Jocko Friday, Feb 3, 17 @ 9:56 am
My dental insurance is finally paying what they owe (via the State) from May 2015, and I’m owed much more. That is how far behind they are. I had to change dentists as a result because I could no longer afford to pay %100 upfront (as my dentist is now requesting), and be in a financial hole for 18+ months. My new dentist is only asking for what my insurance plan dictates I pay.

Comment by Saluki Matt Friday, Feb 3, 17 @ 9:57 am
I am suprised Ms. Kelly did not finish with “so let them eat cake”

Comment by Porgy Tirebiter Friday, Feb 3, 17 @ 9:57 am
Just wondering what the total amount of the premiums we have paid for health coverage are being spent for. It sure doesn’t seem like the funds are being used to pay claims/

Comment by retired Friday, Feb 3, 17 @ 9:57 am
Mr. Rauner is showing true leadership abilities /s

Comment by Anonymous Friday, Feb 3, 17 @ 9:58 am
=…stand with the Governor…=

Sort of like standing with a scarecrow in a cornfield.

Comment by MSIX Friday, Feb 3, 17 @ 9:58 am
I fail to understand how the Governors spokespersons statement helps the parties come to an agreement for a budget. Plus, the medical bills are still past due…..

Comment by Slippin' Jimmy Friday, Feb 3, 17 @ 10:00 am
And let’s not forget the accruing interest. Please note that Ms. Kelly did not address the issue at hand.(shocking) Remember they want to increase employee rates by 100% for this type of coverage.

Comment by oldman Friday, Feb 3, 17 @ 10:01 am
CK, your boss is in charge of the State now. He needs to do his job of preparing and submitting a budget, instead of constantly asking you to blame others for Illinois’ problems.

Comment by Joe M Friday, Feb 3, 17 @ 10:01 am
one of the problems in Chicago is that without a trauma center at U of C hospital (one coming back in a couple of years after a 30 year absence), and other care avoided at that hospital, the burden is placed on other hospitals. and there are the substantial backlogs in payment from the State that are subsidized while awaiting funds due.

Comment by Amalia Friday, Feb 3, 17 @ 10:04 am
I know Mendoza gets panned on here pretty frequently as something of a partisan lightweight, but I, personally, appreciate her continuing to shine a light on these issues, and pointing to the culprit(s). I don’t really care if what she says is also politically expedient; it happens to be true. This situation isn’t “just” highly unethical, it’s blatantly illegal, and it has to stop.

“Ck” and her handlers are an embarrassment. Lately, I’ve begun reading her statements with one eye closed, to shield myself from the full force of the ridiculous political blame-deflection and hackery. …

Comment by Crispy Friday, Feb 3, 17 @ 10:04 am
In November we were still getting bills from when my wife was pregnant. Our daughter was born in July, 2015

Comment by JohnnyPyleDriver Friday, Feb 3, 17 @ 10:05 am
I love the stock form paragraph now used in response to a criticism. Fill in the name, fill in the number of years, hit send.

Comment by Archiesmom Friday, Feb 3, 17 @ 10:06 am
Crispy, some folks will say and do anything for a paycheck (even without an appropriation).

Comment by Anonymous Friday, Feb 3, 17 @ 10:06 am
Can someone tell CK that her definition of an unbalanced budget is a bit off. For 10 years there have been gimmicks to make things balance; yes - but never has there been a gross out of balance like today.

Comment by Anonymous Friday, Feb 3, 17 @ 10:07 am
Dear Bruce,

Me again. I hate to inform you that neither budget that you have introduced has been anywhere close to being balanced. I also further regret having to inform you that you have continued to push for pension holidays during this impasse. So your continue criticisms of past improper actions taken by the State of Illinois, while not inaccurate, lose much of their validity while you continue to push for similar actions.

And while massive borrowing may not have been part of your budget proposal, some may consider forcing vendors to provide goods and services to the State while not having a mechanism to pay them a form of borrowing. Though since you have to date resisted all efforts to pay them, it is probably more accurately called stealing.

On the State employee pay issue, I know that it is hard for someone in your position to have to take the arrows in the event of a government shutdown, and that your constitution does not really allow you to be blamed for things if you cannot easily shift fault to others, but this is the job you signed up for. Spending money willy-nilly without an appropriation to give your employees bonuses, or hire staffers for new and largely symbolic agencies (bicentennial commission) without oversight or legal authority is not the type of activity that generally occurs in the United States and lacks any semblance of transparency or good governance.

Hope you’re hanging in there. Sorry about the Steelers loss to the Pats.
-Juice

Comment by Juice Friday, Feb 3, 17 @ 10:08 am
Keep in mind that the State forced all the 65+ retirees into Medicare Advantage programs. The retirees didn’t have a choice in the matter.

This was done so the State could save money on the retirees’ health insurance.

Just think how far behind the State would be without those savings …

Comment by RNUG Friday, Feb 3, 17 @ 10:08 am
She’s right next to you with “no budget no pay” remember when

Comment by Rabid Friday, Feb 3, 17 @ 10:23 am
The state payment cycle to vendors was under 30 days when Quinn left office.

This spike in the backlog of bills has nothing to do with what happened in past decades. The backlog has exploded during Rauner’s term.

Comment by wordslinger Friday, Feb 3, 17 @ 10:23 am
My wife and I (UIUC) haven’t been to a dentist in two years now. We finally received reimbursement for my wife’s crown 18 months afterwards, but generally speaking we can’t afford to pre-pay right now. We have foster children and aren’t getting reimbursed for their expenses, so something’s got to give.

Other healthcare providers (not just dentists) also won’t see us unless we pay up front and submit it through insurance ourselves, but we can’t afford that right now either. Especially since they’re talking about making us pay twice as much for the health insurance that we can’t use, retroactive through 2015.

The current plan is to get out of dodge as soon as possible.

Comment by Anonymous Friday, Feb 3, 17 @ 10:24 am
I just got off the phone with Cigna
They are paying bill through 6/11/15

Comment by Anonymous Friday, Feb 3, 17 @ 10:29 am
Is there a school where people like CK and Kellyanne Conway went to, to learn how to come up with their responses?

Comment by Joe M Friday, Feb 3, 17 @ 10:29 am
How can they get away with not paying at least the Medicare Advantage claims? Those are tied to the Federal Medicare program. You would think someone at the Federal level would be stepping in sometime soon.

Comment by ANONIME Friday, Feb 3, 17 @ 10:30 am
CK needs her paycheck so she can continue to criticize GA members that have gone without a paycheck for months.

Comment by A Jack Friday, Feb 3, 17 @ 10:34 am
== How can they get away with not paying at least the Medicare Advantage claims? ==

MA plans are ran by private insurance companies, not the Feds. They just have to meet certain federal rules, like providing all normal Medicare services.

Comment by RNUG Friday, Feb 3, 17 @ 10:38 am
Just a few minutes ago, I got a call, at work from a law firm regarding outstanding medical bills my husband and I owe, I carry the health care for our family. We both had surgery in the last year and I had had follow up treatment. You can imagine the medical bills. I am paying into the system for coverage but the system is not doing what it should. We are trying to be healthy and follow up with doctors as advised. How long before our doctors stop seeing us?
This is unacceptable!

Comment by Because I said so..... Friday, Feb 3, 17 @ 10:52 am
This doesn’t phase Rauner one bit. He has made a $50,000,000.00 down payment to see this to the end. He doesn’t care about a balanced budget, higher education, bill backlogs, state employees etc. $50 million says he does not care.

Comment by don the legend Friday, Feb 3, 17 @ 10:54 am
Out of curiosity, is there foundation to bring a cause of action for breach of contract as the insured? The insured is paying for the right to visit a doctor and have insurance pay for coverage that is not being paid. As a result, doctors are refusing to accept the insured as a patient without full payment due to failure of the state to pay claims?

Comment by bothanspy Friday, Feb 3, 17 @ 11:18 am
Dear Because I said so -
This is unacceptable. Just the chorus! Social Service providers have been saying this for over 550 days now.
Everyone needs to scream at the top of their lungs in everyway possible “PASS A BUDGET - THIS IS UNACCEPTABLE”

Comment by Feel The Pain!!! Friday, Feb 3, 17 @ 11:20 am
What’s the difference between Nora virus and the Turnaround Agenda/unpaid medical and dental bills?

While they all make you want to throw up, the Nora virus eventually goes away./s

Comment by DuPage Friday, Feb 3, 17 @ 11:51 am
I would say I’ve seen this movie many times before, but actually I keep seeing a much worse, more bizarre movie every month. Or maybe these are more like episodes of the Twilight Zone. NO ONE runs an employee benefit fund like this. Pointing fingers to who sinned in the past is not helpful because everyone who proposed or voted for a budget since Blago took office has sinned bit league, except for the years where the budget was supported by revenue from the temporary income tax increase!

Comment by formerpro Friday, Feb 3, 17 @ 12:01 pm
–Out of curiosity, is there foundation to bring a cause of action for breach of contract as the insured?–

Sure, but you have to file the case in the Court of Claims. If you win, after a long time, you will be paid when the legislature appropriates the money.

Comment by Bigtwich Friday, Feb 3, 17 @ 12:02 pm
-Sure, but you have to file the case in the Court of Claims. If you win, after a long time, you will be paid when the legislature appropriates the money.-

I meant more on a class-action level.

Comment by bothanspy Friday, Feb 3, 17 @ 12:15 pm
I know the State didn’t mean it to happen, but the best thing they ever did was to switch us to the United Healthcare advantage plan.

Comment by Retiree Friday, Feb 3, 17 @ 1:08 pm
Since the State is causing the problems, the legislature should enact a law that prevents medical providers from denying appointments or requiring prepayment from State of Illinois health insured persons. The person in need of medical care should not be made to suffer due to the Governor and legislatures failures.

Comment by RIJ Friday, Feb 3, 17 @ 1:11 pm
How can the state be behind on paying claims when all state workers have premiums taken out every paycheck and are 100% up to date of funding health and dental insurance? Where is that money? If State Farm did this they would be in trouble for fraud.

Comment by don't get it Friday, Feb 3, 17 @ 1:36 pm
== Since the State is causing the problems, the legislature should enact a law that prevents medical providers from denying appointments or requiring prepayment from State of Illinois health insured persons. ==

That is part of some of the health insurance contracts with the State. Those insurance companies networks are supposed to provide services regardless. But not all end providers are part of those networks.

Comment by RNUG Friday, Feb 3, 17 @ 1:47 pm
“Comptroller Mendoza spent 10 years in the General Assembly …” CK then goes on to blame everything on those 10 years.

CK, you know what, the GA wasn’t perfect back then but they were a h*** of a lot more functional than the Rauner government. They passed budgets, paid the state’s bills and fulfilled the state’s obligations.

And GA hasn’t changed that much. As a programmer, when things stop working we look to what has changed. Governor “Gridlock” Rauner is the new variable in this. If he could only stop campaigning for re-election long enough to actually govern a little, we could get something done.

Comment by Anonymous Friday, Feb 3, 17 @ 2:52 pm
bothanspy, there IS a class-action suit that is seeking to force the state to resume claim payments. It was filed April 13, 2016 by an employee at Northern Illinois University. You can follow it here: https://goo.gl/3u70d0

The media reported on the case when it was filed last spring, but it has been mostly ignored since then.

Comment by tobias846 Friday, Feb 3, 17 @ 2:53 pm
–How can the state be behind on paying claims when all state workers have premiums taken out every paycheck and are 100% up to date of funding health and dental insurance? Where is that money?–

They are paying claims with the portion taken out of paychecks. They are not able to pay the State’s portion for workers’ benefits because of the lack of a budget. Therefore, they are paying claims with the fraction of the funds they have, as they become available, and a backlog has resulted and grows larger by the day.

Comment by Ron Burgundy Friday, Feb 3, 17 @ 3:15 pm
The interest on the unpaid claims, $351 million, is more than twice the estimated cost, $172 million, of insuring all Medicare Advantage participants in all pension plans in FY 2016. Still don’t understand why pension plans aren’t buying these claims.

Comment by CapnCrunch Friday, Feb 3, 17 @ 3:29 pm
I would think that people who have avoided medical tr eatment because they can’t afford to pay upfront while “insured” and then develop a serious condition (or they already have a condition and it gets worse or death results because of this financial issue), would certainly have grounds to hold the state reponsible. Lawyers should be on this.

Comment by Anonymous Friday, Feb 3, 17 @ 3:39 pm
Two points. First, there is a lawsuit over this very issue in Cook County.

Next, there is a program where a private company pays the provider 90% of its claim immediately. The private company keeps all interest when the claim is finally paid and upon final payment, the private company also pays the additional 10% to the provider. Therefore, under the worst-case scenario, a patient would only have to pay 10% up-front. These programs are all listed on the state websites. But in fact, many providers that can afford it would prefer the 9-12% interest on their claims. Can’t get that anywhere!

Comment by No Raise Friday, Feb 3, 17 @ 3:39 pm
I have friends whose whole work lives were at SIU. As such, they are not eligible for Medicare. After retiring they moved out of state. Now, the university-affiliated hospital in the state where they live will no longer take their insurance. When one of them needed a battery in a pacemaker replaced, they were told they had to pay up front because of the backlog of bill that had been unpaid by the state.

Comment by redeft Friday, Feb 3, 17 @ 3:43 pm
“Can’t get [9-12%] anywhere!”

That’s my point. SURS earned .2% in FY 2016. Buy all of these claims, it’s as safe as buying US Treasury notes but at a much better return. Instead of private investor getting the free money the taxpayers are clawing back some of their money.

Comment by CapnCrunch Friday, Feb 3, 17 @ 4:09 pm