FOR IMMEDIATE RELEASE:
February 19, 2002

FOR INFORMATION CONTACT:
Kelley Elwood at (312) 580-6497
                   cell: (312) 680-3620

Doctors, Health Professionals Seek
Fairness, Major Improvements to
Insurers' Contracting and
Administrative Practices

Springfield, IL – A coalition of Illinois health care professionals and providers introduced legislation last week that requires insurance companies to adopt common, fair business practices that will be understandable to patients, physicians and health professionals who depend on them. HB 6032, "The Fairness in Health Care Services Contracting Act," will be heard in the House Registration and Regulation Committee this Thursday, February 21.

"It's important that our patients get the best possible health care. But care decisions are often directed by health plan contracts. We want to be in the best position – an informed position – to manage our offices and deliver that care," said Ronald L. Ruecker, M.D., president of the Illinois State Medical Society.

"Business practices vary so drastically between plans that doctors and other providers spend way too much time sorting through murky details and dealing with the aftermath of confusing and misleading administrative procedures," said Dr. Ruecker. "We want the rules to be clearly spelled out, and we want clear, understandable information to effectively run our offices and treat our patients. This isn't asking for too much," added Dr. Ruecker.

Some such rules and procedures are contained in contracts between health care professionals and insurers. But the language is often highly misleading and ambiguous. Standardization and simplification of misleading and questionable contract provisions are what health care professionals and providers are seeking through legislation.

"Most businesses strive to tailor their operating procedures, systems and policies to be consumer-friendly, " Dr. Ruecker noted. " They see that it gives them competitive edge. But the opposite seems true with insurers: they seem to regard arcane and clandestine operational philosophies as integral to their business. We are out to firmly dispel that notion. "

The "Fairness in Health Care Services Contracting Act" – introduced in both the Illinois House and Senate – details a menu of comprehensive reforms that would improve the health care environment in Illinois, positioning physicians and patients as equal partners with the health plans that serve them. Its provisions include commons sense business practice reforms such as:

• Giving health professionals and providers at least 30 days to review a complete contract from an insurer prior to signing it;

• Prohibiting insurers from making, unilateral, mid-stream contract changes, without allowing health professionals and providers the opportunity to review the changes and terminate altered agreement;

• Requiring that insurers provide specific written explanations when they try to recoup claims money – sometimes years after it has been paid – and limiting the timetable for doing so to two years;

• Giving health professionals and providers the right to know what they will be paid for specific services prior to signing a health insurance contract; and

• Assuring health professionals and providers an opportunity to opt-out of a contract or network before insurance companies silently rent it out at different rates and contract terms – all unknown to the health professional/provider.

HB 6032 is sponsored by Rep. Angelo "Skip" Saviano (R-Elmwood Park); the Senate companion, SB 1848, is sponsored by Senator Tom Walsh (R-LaGrange Park). The bills were first introduced in the Illinois General Assembly last February. Prior to the session recess in May, the General Assembly adopted a resolution establishing a legislative task force to study the issues raised by the legislation. Over the past several months, the task force convened hearings and deliberated on the issues. A report of its findings is imminent.

"We are expecting to attract a broad range of support in the legislature this session. In fact, we're already beginning to see these issues addressed in the platforms of various candidates, including the race for Illinois governor," Dr. Ruecker said. He concluded, "This initiative is the number one priority of ISMS on behalf of our members. The system is unacceptably skewed right now to protect big insurance. We want to change that balance and are committed to going all out to achieve it."
www.isms.org

The Illinois State Medical Society represents over 15,000 physicians statewide practicing in all specialties.

Dr. Ruecker is a board-certified internist specializing in gastroenterology. He practices in Decatur, IL.