Budget Impasse Raises Health Insurance Questions

The budget impasse has raised questions about health insurance coverage

when UIC personnel need to see medical practitioners.

By Susan S. Stevens

YOU SPRAINED your ankle. Or, your child’s asthma has flared up. You have insurance through your job at UIC, but your doctor wants you to write a check or put the bill on your credit card. What do you do?

FIRST OF ALL, yes, you still have insurance despite the State of Illinois having no budget for this fiscal year. It simply is that the Illinois Central Management Services (CMS), the unit of State government that handles employee insurance, does not have the legal authority to pay claims or premiums to vendors providing fully insured HMO coverage. Those payments stopped in September last year. (See further details toward the end of this article.)

EMPLOYEES WITH fully insured HMO plans should have no problem. These -- such as BlueAdvantage, HMO Illinois, Health Alliance, and Coventry HMO -- have agreed to continue paying claims to healthcare providers on their normal schedule.

BUT FOR the others …

Who can help you?

THE STATE of Illinois pays the direct cost of each claim, rather than paying a monthly premium, to the Quality Care Health Plan (QCH\IP) and two Open Access Plans (OAPs). The State has placed these payments on hold. Katie Ross, Senior Director of Human Resources Administration, University of Illinois, said out-of-network dental and mental health providers have been asking employees to pay up front and await reimbursement.

SEEK TREATMENT as needed, according to CMS. “As a covered plan participant, your medical, prescription, dental and vision coverage is still in effect and has not been reduced in any way. Claims continue to be processed by the plan administrators in accordance with the applicable plan design.”

IF YOU are asked to pay up front for a service, contact the administrator of your insurance plan, CMS said. “Your plan administrator will contact the provider to try to find a resolution. If a resolution cannot be reached and the provider continues to ask for an upfront payment, you should make arrangements with your provider to be reimbursed once the provider receives payment from the plan, including any interest that may apply to your claim.”

FOR IN-NETWORK providers, only your normal co-payment or co-insurance should be requested. However, if your doctor, pharmacist, or other health care provider insists on immediate payment, and you cannot pay, contact your plan administrator immediately. You should find a phone number on your insurance card.

Phone numbers for:
Cigna: 800-962-0051
HealthLink OAP 800-624-2356
Coventry OAP 800-431-1211
Delta Dental 800-323-1743

IF YOU still do not have the right phone number, call the Central Management Services Group Insurance Division at 217-558-4486 during normal business hours.

ROSS POINTS to a set of frequently asked questions on the CMS website: http://www.illinois.gov/cms/Employees/benefits/StateEmployee/Documents/Budget_Impasse_FAQs_092415.pdf

EMPLOYEES WHO have a specific question or concerns regarding a medical claim payment can contact the CMS Member Services group by phoning that 217-558-4486 number or emailing CMS.WebsiteBenefits@illinois.gov.

FOR INQUIRIES regarding the State’s hold on dental claims: 844-350-4432. General customer service questions, including claims, should continue to be directed to 800-323-1743.

What to expect in the future?

DESPITE THE budget impasse, insurance premiums are still being deducted from your paychecks. That will continue. Some good news: if you pay your medical bills yourself, you may be offered nine percent interest when the State reimburses you if payments are delayed too long.

CMS SAID it will update information as it becomes available at http://www.illinois.gov/cms/Employees/benefits/StateEmployee/Pages/QCHPQCDPClaimPaymentDelay.aspx

A CMS spokeswoman issued the following statement March 22:

“DUE TO decades of fiscal mismanagement, the State Employee Group Insurance Program has been underfunded for years. Healthcare providers and carriers have regularly managed payment delays of eight months or longer. These payment delays will continue until the General Assembly passes a balanced budget. We are hopeful that the General Assembly will act soon to pass a balanced budget and enact real reforms so claim payments to our group health insurance program can resume.

“CMS AND the health plan administrators are working diligently with healthcare providers to try to avoid having providers charge members up front for services and to ensure there is no interruption of service. Any state group health insurance member having any problems receiving services should first contact their health plan administrator directly for assistance.  Members may also contact the CMS Group Insurance Division at 800-442-1300 for further assistance.”

CMS ADDED: “A list of all healthcare vendor websites and contact information is available at www.benefitschoice.il.gov.”

State employee contract unsettled

ALONG WITH the State budget, a new contract for the State’s largest employee union – AFSCME – is in limbo. Negotiations have been underway for months. While the negotiations cover the full range of employee benefits, such as salary, they also pertain to insurance.

GOVERNOR BRUCE Rauner said in a statement Jan. 15 that only employees who choose the State’s “expensive, platinum health plan will see twofold increases to help cover a fraction of the cost of this plan.” He said AFSCME was “misleading at best” when it said the State would double health insurance premiums. Rauner said no increase in premiums was proposed except for the platinum policyholders.

EVERYTHING IS on the table, University of Illinois President Timothy Killeen said in a March 7 letter to the UIC Academic Professional Advisory Council Executive Committee and others. Rauner is seeking a ruling from the Illinois Labor Relations Board (ILRB) confirming that an impasse has been reached. “The Governor continues to urge that AFSCME take the State’s ‘best and final’ offer to its membership for a ratification vote, and the State may be able to implement its last offer if the ILRB agrees that an impasse exists,” Killeen wrote.

KILLEEN ALSO noted that the University will broadly communicate any changes for the University community.