SPRINGFIELD — Approaching a 10th month without a budget, Illinois has racked up a mound of unpaid claims, about $2.8 billion worth, in its state employee group insurance program.
Payment delays to health insurers and providers are now averaging 15 months, according to Meredith Krantz of Illinois Central Management Services. That's due not only to the current budget impasse but years of under-funding in the group insurance program that has caused regular payment delays of eight months or longer, she said.
The current hold on claims is split nearly down the middle, with $1.4 billion owed for the state's self-insured plans, and $1.5 billion for the fully insured plans, she said. Fully-funded plans are the HMOs and Medicare Advantage plans; the self-insured plans include Coventry Health Care Open Access Plan, Health Link OAP, Cigna (Quality Care) and Delta Dental.
As of today, the state owes one local carrier, Carle-owned Health Alliance Medical Plans, $720 million for 16 months' worth of premiums at $45 million a month, according to Health Alliance spokeswoman Laura Mabry.
Locally, at least two medical providers — the Carle health system and the Presence Health hospitals in Urbana and Danville — are waiting out the state budget impasse without imposing any billing or service changes on their state employee patients, their spokesmen said.
"We treat this no differently than we ever have," said Deb Schimerowski, chief financial officer for Presence Covenant and Presence United Samaritans medical centers. "We accept the insurance and just wait for the state to pay us."
Together, the two hospitals are now waiting on $1.73 million in claims for the care provided to patients in the state employee group insurance program, she said. Most of that money is owed to Covenant, which serves more state employees than United Samaritans does, she said.
This is also just a fraction of what the state owes the two hospitals overall, when unpaid claims for two Medicaid programs are factored in, Schimerowski said. Claims in all three programs date from four to 15 months back, she said.
"It's just part of the whole, bigger picture with the state between the three plans," she said. "The state really owes us over $4.6 million at each hospital that is over four months old."
Presence Health announced plans last week to reduce 700 jobs throughout its system this year after posting about a $186 million loss on operations for 2015. In terms of the extra impact from the state budget situation, Schimerowski said, the Urbana and Danville hospitals are "fine with our cash. But this does slow us down with what we'd like to do with ongoing capital acquisitions."
The Carle health system continues to receive payments for services from some — but not all — plans covering state employees, and the amount of money it's owed by the state continues to grow, Mabry said. Like both Presence hospitals, Carle is continuing to require patients to pay only their own part of the bill that insurance won't cover, such as co-payments and co-insurance, while the budget impasse continues, she said.
Health Alliance is managing the state payment delay by using Central Management Service's Vendor Support Initiative to keep claims paid on time, Mabry said. That program is allowing vendors affected by Illinois' budget situation to seek out help through private transactions.
Krantz said CMS and health plan administrators have also been working with health care providers around the state to help avoid billing impacts and service interruptions for state group insurance members. Anyone having a problem is advised to first contact their health plan administrator directly for help. Members can also call CMS Group Insurance Division at 800-442-1300 for further assistance, she said.