The Health Reporter Is In: June 29, 2017

The Health Reporter Is In: June 29, 2017

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Q: Two questions about state employee group health insurance and medical bills: Is it true that Carle has sold off some of its debt related to the state budget impasse? And while there's still no state budget, what can state employees do if they're being harassed over medical bills that haven't been paid through their group health plans?

A: Only one piece of the Carle system, Health Alliance Medical Plans, has sold its state debt.

Since 2013, Health Alliance has sold $1.5 billion in state receivables, or to be more specific, the premiums for health coverage for state employees and their dependents that the state hasn't paid, according to the company.

Health Alliance said it's still currently owed $215 million related to the state's group insurance program.

"Working with the state on any unpaid amount is an ongoing process," spokeswoman Laura Mabry said.

In selling its premium debt, Health Alliance is among the vendors that are owed money by the state and using a relief program offered by the Department of Central Management Services that was established in the absence of a state budget.

State vendors who qualify for the Vendor Payment and Vendor Support Initiative programs include HMO and fully insured carriers including Blue Cross Blue Shield of Illinois, Aetna and Health Alliance, along with other state vendors eligible under the Prompt Payment Act, according to CMS.

Meanwhile, unpaid medical bills for state employees and their dependents continue to pile up.

Just those at the Comptroller's Office to be paid out of the General Revenue Fund now total $4.13 billion, Jamey Dunn, a spokeswoman for Comptroller Susana Mendoza, said. That figure doesn't include unpaid insurance premiums, she said. Nor does it include any of the medical bills that are part of the backlog still at state agencies.

If state employees are being squeezed by providers to pay money they don't really owe on what were covered medical services, they're likely in the state's self-insured group health plans (administered by HealthLink, Coventry and Cigna) because money to pay the claims has to be funded under state appropriation.

Processed HealthLink and Coventry claims for insured state employees and their dependents were last released at various points in 2015.

Under the latest update from CMS on June 23, HealthLink OAP claims processed through Aug. 30, 2015 and Coventry OAP claims processed through Nov. 25, 2015 have been released. More information on where self-insured claims payment delays stand can be found at: http://bit.ly/2tiaFNn

State employees having payment, coverage or collections issues are being urged to immediately contact the CMS benefits team or their own group insurance representatives. According to CMS, it's benefits team has worked aggressively to resolve billing issues and maintain service for state employees when they've had issues over billing.

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