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Information Articles: Insurance

State Health Claims Backlog Continues to Grow

Wednesday, February 8, 2017   (0 Comments)
Posted by: By Lindsay Wagahoff, ICS Director of Governmental
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The State Employees Group Insurance Program (SEGIP) lack of payment is a topic for many of our chiropractic physicians. Many providers are waiting to be paid for the care they have provided to their state employee patients. Although this situation is not new to the State of Illinois and started before the current budget impasse, unfortunately, the continued budget impasse at the Capitol is making the situation worse. As of the writing of this article, the State of Illinois backlog of total unpaid bills is well over $10 billion.

Recently, the Commission on Government Forecasting and Accountability (COGFA) released that at the end of December approximately $3.91 billion in claims for SEGIP was being held by the State. These claims are owed to various insurers, organizations, and companies.  The largest portion of these claims is under the HMO/Medicare Advantage plans, followed by the Open Access Plans claims and then claims through CIGNA.

COGFA also reported the “estimated time of claims to be held for the Managed Care/Medicare Advantage Plans was 303-675 days, 468-524 days for Open Access Plans and 398-608 days for CIGNA.” Essentially, this means a claim under the Managed Care/Medicare Advantage Plans is being held between 303- 675 days before payments are made. COGFA also indicated in their report that claims and hold times will continue to increase the longer the State goes without a budget.

In addition to a growing backlog, the State has requirements to pay interest on those bills. Under the State Prompt Payment Act, the State of Illinois is required to pay 1.0% interest on bills that have been approved for payment for more than 90 days. In a recent interview with WICS Channel 20, State Comptroller Susana Mendoza (D-Illinois) estimates that the unpaid medical bills alone are going to result in $2 million per month in late interest penalty payments. Please note, this number does not include the amount of interest that will be required to be paid for other unpaid bills.

The pressure for the State to pass a budget continues to grow from various groups including but not limited to: human service providers, vendors, and medical providers. Many of these groups have been waiting for payment for a variety of services they have provided to the State.  In the interview with WICS Channel 20, Comptroller Mendoza indicates that she has received letters from patients who have been denied healthcare because the State of Illinois has not paid the provider.

When the State does pass a budget, this situation will not be resolved immediately. It will take time for the State to catch up on the backlog of bills.  Therefore, the ICS continues to advocate for our members on this matter and will continue to keep chiropractic physicians updated on the issue.  If you have any questions or need additional information do not hesitate to contact the Illinois Chiropractic Society.



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