State May Quit Paying Some Insurance Claims Due to Budget Impasse

THE LACK of a State budget has put the Illinois Department of Central Management Services (CMS) in unchartered territory with respect to funding critical State services, including healthcare services for all plan participants enrolled in the State Employees Group Insurance Program.

ACCORDING TO a memo from Tom Tyrrell, Director of CMS, covered plan participants’ medical, prescription, dental and vision plan services will continue. “We have been working with, and will continue to work with the plan administrators contracted with the State for these vital services,” Tyrell wrote. “All healthcare services will continue to be paid as long as possible. However, in the near future, we will no longer have the legal authority to continue to pay healthcare vendors for their services.

“SINCE THE healthcare providers don’t know when they will be reimbursed for the care they provide,” Tyrell continued, “a few of the providers in our self-insured plans (i.e., Cigna, HealthLink OAP, Coventry OAP, and Delta Dental) have asked our members to pay cash at the time of service. If this occurs with a dental claim, the provider will file the claim on behalf of the member and the member will be reimbursed directly by the plan. In the case of a medical claim, the provider will reimburse the member once the provider receives payment for the services.

“ONCE A budget is approved and appropriate funding is in place, the State of Illinois will resume release of payments for healthcare services,” Tyrell wrote. “We appreciate your understanding in the face of these extraordinary circumstances. We will continue to do everything in our power to mitigate the impact on you as we navigate through this budget impasse. Please continue to visit the ‘Latest News’ section on the Benefits website at www.benefitschoice.il.gov for information pertaining to your healthcare. This website will be updated as new information becomes available.”

IN A Sept. 17 email communication, University Human Resources reported, “We have heard from some health care providers, including UI Health, Carle, and Christie Clinic, and they tell us that as of now they are conducting business as usual. We understand that with most providers affiliated with large clinics, hospitals, or organizations, there should be no change in how you are charged at the time of service.”

IF YOU are in either the Quality Care (Cigna), Coventry OAP, or HealthLink OAP and you receive care or have an upcoming appointment with an independent provider, you may still wish to call ahead and confirm expectations for payment at the time of service.

DELTA DENTAL also provided further information from Delta Dental, which can be read in their bulletin on the DeltaDental of Illinois website.