http://ift.tt/2dKt4qN Dean Olsen Staff Writer @deanolsenSJR
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.
“Under normal circumstances, Springfield Clinic would not bill the patient’s responsibility (co-insurance) until after the claim had been paid by insurance,” the Oct. 10 letter states. “However, because the state is so delinquent in its payments, Springfield Clinic has decided to temporarily deviate from our standard billing practice.”
The outstanding amounts owed to the clinic by patients for their share of costs covered by the Cigna/Quality Care and HealthLink open-access plans total about $2 million, according to Mark Kuhn, the clinic’s chief administrative officer.
“It helps us catch up a bit,” Kuhn said Monday, noting that the clinic has been drawing on its reserves to deal with the fall 2015 shut-off of payments from the state’s self-funded insurance plans for employees, retirees and dependents.
Each patient’s share of the overdue bills will average less than $500, Kuhn said.
“We’re just doing catch-up on member balances,” he said, adding that the clinic offers patients payment plans.
The fully insured plans that cover state workers — including plans provided by Health Alliance, Blue Cross and Blue Shield of Illinois, and Coventry Health Care — continue to pay doctors, hospitals and other providers. Those plans are paying providers voluntarily even though the state is far behind on paying fully insured plans their monthly premiums.
Springfield Clinic, a multi-specialty group practice of physicians, is among health-care providers in Springfield that are dealing with record delays in payments related to a budget impasse that began in July 2015.
The overdue payments now total at least $183 million, with no end in sight to the political bickering that led to the situation.
The stopgap state spending plan adopted in late June by the Democratic-controlled General Assembly and Republican Gov. Bruce Rauner did little to resolve the delays in payments to health care vendors in Springfield and elsewhere.
Since July 1, $328 million in payments to vendors have been either sent or put in a pipeline to have checks issued, according to Meredith Krantz, spokeswoman for the Illinois Department of Central Management Services.
A portion of that money represents premiums paid by members, she said. The state’s remaining unpaid health care bills for employees, retirees and dependents total about $3.52 billion, she said.
“CMS remains hopeful that the General Assembly will pass structural reforms along with a comprehensive, balanced budget that includes fully funding the State Employee Group Health Insurance Program,” Krantz said.
Bryan Engelbrecht, 35, a Cantrall resident who works as a site interpreter for the Illinois Historic Preservation Agency, said he doesn’t blame Springfield Clinic for asking patients to pay their share of total medical bills.
He was, however, confused by the wording of the clinic’s letter. At first, he thought the letter meant that he would be billed for the full cost — his share plus his employer’s share — of services provided to him, his wife and their 2-year-old fraternal twins in 2015 and 2016.
When he called Springfield Clinic’s billing department, Engelbrecht said he was informed he would be billed only for his family’s share for certain bills during that time period.
But the new amount he now owes wasn’t available. That amount apparently will be reflected in future monthly bills, he said.
‘Weather the storm’
Despite the growing backlog of health care claims, several major providers in Springfield indicated they will continue to wait until they are paid by the state before billing patients for their share. That amount can vary by family based on the health plan.
Memorial Health System, which has delayed at least one multimillion-dollar building project because of the backlog, is owed $86 million by the state. About $64 million of the total is owed to Memorial Medical Center.
Even though the system’s hospitals and physician group will continue to wait for state payments before they bill patients for deductibles and co-insurance, chief executive officer Edgar Curtis didn’t find fault with Springfield Clinic’s decision.
The health system and hospitals are not-for-profit, charitable institutions that benefit from property tax exemptions, Curtis said. The clinic is a for-profit business.
“We’ve got more responsibility to the public,” Curtis said. “We’re going to continue to weather the storm.”
Medicaid bills, which are funded by the state and federal government for the care of low-income people, are being paid largely on time because of court orders, Curtis said.
HSHS St. John’s Hospital and HSHS Medical Group will continue to wait for overdue state payments before billing patients, representatives said, adding that St. John’s is owed $46 million.
SIU HealthCare is owed more than $5 million but doesn’t plan to collect from patients until the state pays its share, according to Karen Carlson, spokeswoman for Southern Illinois University School of Medicine.
“Resolution of these payment delays is critically important to SIU and all health care providers across the state,” she said.
State workers, retirees and their dependents represent about one-third of Springfield Clinic’s commercial business — separate from Medicaid and Medicare.
“We remain hopeful the state of Illinois will resolve its financial problems soon and we will be able to return to our normal billing processes,” the clinic’s letter from chief financial officer Alan Nerone says.
The clinic hasn’t ruled out asking patients at some point in the future to also pay the state’s share of their bills. There are no plans right now to take that unprecedented step, but if it happens, Kuhn said the clinic would reimburse patients after receiving state payments.