093_SB1776
LRB093 03728 JLS 03758 b
1 AN ACT concerning insurance.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Insurance Code is amended by
5 adding Section 368e as follows:
6 (215 ILCS 5/368e new)
7 Sec. 368e. Recoupments. Any attempt to recoup payments
8 shall be initiated by providing a written explanation of any
9 proposed recoupment, including, but not limited to, the name
10 of the patient, the date of service, the service code, and
11 the payment amount, the details concerning the reasons for
12 the recoupment, and an explanation of the appeal process. A
13 health care professional or health care provider shall be
14 given 60 days to appeal the proposed recoupment or to repay
15 the recoupment amount. If the professional or provider
16 chooses to appeal the proposed recoupment and, upon appeal,
17 the proposed recoupment is determined to be appropriate, the
18 professional or provider must pay the recoupment within 30
19 days of receiving the notice of the final appeal's decision.
20 If the professional or provider does not make any required
21 recoupment payment within these time frames, the company may
22 offset future payments to effectuate the recoupment. Except
23 in an instance in which the health care professional or
24 health care provider has been found guilty of committing
25 civil or criminal insurance fraud, no recoupment of any
26 payments may be initiated 24 months after the date the moneys
27 were paid.
28 Section 99. Effective date. This Act takes effect on
29 December 1, 2003.