FOR IMMEDIATE RELEASE:
January 1, 2004
FOR INFORMATION CONTACT:
Kelley Elwood, 312/580-6497
Elizabeth Morgan, 312/853-6528
FAIRNESS BECOMES LAW
Insurer information will help doctors help patients
Chicago – Physicians will be in a better position to advocate for patient care thanks to a new law that takes effect today. The Fairness in Contracting Act, a priority of Illinois State Medical Society for the past three years, entitles physicians and other health care professionals to receive much needed information regarding proposed contracts and administrative procedures from health insurers, information essential to running a successful medical practice and thereby providing high quality patient care.
“We’ve been looking forward to this day for a long time,” said ISMS President William E. Kobler, M.D. “By requiring health plans to be upfront in providing essential information, physicians can better manage patient care. Illinois citizens should be encouraged to know their health care team is working in a more fair and equitable manner on their behalf.”
The Fairness in Contracting Act applies to the distribution of information only, and will not alter current payment methods. It will, however, provide vital first steps in restoring sensible business practices between physicians and other health care providers, and insurers, including:
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Contracting procedures - with proposed contracts, physicians and other health care providers will receive all attachments, exhibits, certain specialty-specific fee information and the network administration manual. Once this information is received, physicians will have 30 days to review the contract before signing. Prior to “Fairness,” doctors were forced to sign contracts without knowing what they would be paid for services or how health plans performed
administrative procedures. -
Remittance advice and procedures - a remittance advice must contain detailed information including the services billed, any patient payment responsibility, the actual payment and reasons for any reductions. In the past, many physicians received payment for care, but it was not linked to a specific patient or service, thereby preventing physicians from appropriately balancing their books and running their practices.
- Recoupments - if an insurance company must recoup payments, a detailed explanation containing the name of the patient, dates of service, service code or service description, the amount and the reason for recoupment must be included in the demand for recoupment. Physicians frequently complained that demands for the return of payments previously paid were not accompanied by proper explanation.
“We would like to thank our friends in the Illinois General Assembly as well as other individuals who have supported Fairness over the last three years.” Dr. Kobler stated. “We would also like to recognize one health plan in particular, Blue Cross Blue Shield of Illinois, for breaking ranks with other Illinois health plans and negotiating in good faith with ISMS.”
State Representative Angelo “Skip” Saviano (R-Elmwood Park) and State Senator Denny Jacobs (D-East Moline) sponsored Fairness in Contracting.
“This law is a major step forward for medicine,” said Dr. Kobler. “When health care professionals, providers and insurers work on more even terms, the outcome is improved patient care. Illinois patients are the ultimate winners today.”
Dr. Kobler is a board-certified family physician. He practices in Rockford, IL.
ISMS is a professional membership association representing over 14,000 physicians practicing in all specialties statewide.