FOR IMMEDIATE RELEASE:
July 29, 2003
FOR INFORMATION CONTACT:
Kelley Elwood, 312/580-6497
Elizabeth Morgan, 312/853-6528
FAIRNESS SIGNED INTO LAW
Health Insurers to Develop Better Business Practices, Strengthen Health Care Team
Chicago – Legislation signed into law last week will help physicians make more informed decisions about health care resources by standardizing and simplifying contracts presented to them by health plans. The Fairness in Contracting Act (H.B. 1074), which has been a priority of the Illinois State Medical Society for the past three years, will put physicians in a better position to advocate for patients.
“Passage of this bill injects a needed dose of trust into the physician-insurer relationship,” 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.”
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:
- 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.
- 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.
- 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 remittance advice.
“This is an important first step in bringing more equity to the business side of medicine,” said Dr. Kobler. “Patients should be encouraged to know that their health care team is taking steps to better advocate on their behalf.”
Illinois House Representatives Angelo “Skip” Saviano (R-Elmwood Park), Barbara Flynn Currie (D-Chicago), Frank J. Mautino (D-Spring Valley), Sara Feigenholtz (D-Chicago), Mary E. Flowers (D-Chicago), Rosemary Kurtz (R-Crystal Lake), Dan Brady (R-Bloomington), Robin Kelly (D-Matteson) and Deborah L. Graham (D-Chicago), and Illinois Senators Denny Jacobs
(D-East Moline) and Bill Brady (R-Bloomington), sponsored H.B. 1074. However, it was the unprecedented cooperation between health care professionals and providers, insurance companies, HMOs and other interested parties that led to victory.
“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. This is truly a victory for physicians and patients.”
The Fairness in Contracting Act will take effect on January 1, 2004.
ISMS is a professional membership association representing over 14,000 physicians practicing
in all specialties statewide.
Dr. Kobler is a board-certified family physician. He practices in Rockford, IL
Twenty North Michigan Avenue, Suite 700 Chicago, Illinois 60602 Telephone: 312-782-1654 Toll Free: 800-782-ISMS Fax: 312-782-2028