Full Text of HB1529 097th General Assembly
HB1529 97TH GENERAL ASSEMBLY |
| | 97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012 HB1529 Introduced 2/15/2011, by Rep. Lou Lang SYNOPSIS AS INTRODUCED: |
| 215 ILCS 5/355.3 new | | 215 ILCS 5/368d | |
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Amends the Illinois Insurance Code. Provides that dental insurance plans must list in the fee schedule attached to the contract every Code on Dental Procedures and Nomenclature (CDT) code upon which the plan imposes a capped fee and the dollar amount of the capped fee. Provides that any CDT code not so listed shall not be subject to any fee cap, and the provider may balance bill the patient. Provides that dental insurance plans must highlight any changes in subsequent contract terms or conditions and shall have the original plan administrator notify the enrolled dentist and allow the dentist sufficient time to respond. Provides that no recoupment or offset may be requested or withheld from future payments 366 or more days after the original payment is made. Provides that no contract between an insurer and a health care professional or health care provider may provide for recoupments in violation of the provision concerning recoupment.
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| | A BILL FOR |
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| | | HB1529 | | LRB097 09778 RPM 49922 b |
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| 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 | | changing Section 368d and by adding Section 355.3 as follows: | 6 | | (215 ILCS 5/355.3 new) | 7 | | Sec. 355.3. Dental plans; contracting. | 8 | | (a) Every company that issues, delivers, amends, or renews | 9 | | any individual or group policy of accident and health insurance | 10 | | on or after the effective date of this amendatory Act of the | 11 | | 97th General Assembly that provides dental insurance must list | 12 | | in the fee schedule attached to the contract every American | 13 | | Dental Association's Code on Dental Procedures and | 14 | | Nomenclature (CDT) code upon which the plan imposes a capped | 15 | | fee and the specific dollar amount of the capped fee. | 16 | | (b) Any CDT code not listed in the contract as prescribed | 17 | | in subsection (a) of this Section shall not be subject to any | 18 | | fee cap. In such cases, the provider may balance bill the | 19 | | patient. | 20 | | (c) Every company that issues, delivers, amends, or renews | 21 | | any individual or group policy of accident and health insurance | 22 | | on or after the effective date of this amendatory Act of the | 23 | | 97th General Assembly that provides dental insurance must |
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| 1 | | highlight any changes in subsequent contract terms or | 2 | | conditions, including changes in reimbursement, and shall have | 3 | | the original plan administrator notify the enrolled dentist and | 4 | | allow the dentist sufficient time to review, renegotiate, or | 5 | | terminate the contract.
| 6 | | (215 ILCS 5/368d)
| 7 | | Sec. 368d. Recoupments.
| 8 | | (a) A health care professional or health care provider | 9 | | shall be provided a
remittance advice, which must include an | 10 | | explanation of a
recoupment or
offset taken by an insurer, | 11 | | health maintenance organization,
independent practice | 12 | | association, or physician hospital
organization, if any. The | 13 | | recoupment explanation shall, at a minimum, include
the name
of | 14 | | the patient; the date of service; the service code or if no | 15 | | service code is
available a service description;
the recoupment | 16 | | amount; and the reason for the recoupment or offset. In
| 17 | | addition,
an insurer,
health maintenance organization, | 18 | | independent
practice association, or physician
hospital | 19 | | organization shall provide with the remittance advice a | 20 | | telephone
number or mailing address to initiate an appeal of | 21 | | the recoupment or offset.
| 22 | | (b) It is not a recoupment when a health care professional | 23 | | or health care
provider
is paid an amount prospectively or | 24 | | concurrently under a contract with an
insurer, health
| 25 | | maintenance organization, independent practice
association, or |
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| 1 | | physician
hospital
organization that requires a retrospective | 2 | | reconciliation based upon specific
conditions
outlined in the | 3 | | contract. | 4 | | (c) No recoupment or offset may be requested or withheld | 5 | | from future payments 366 or more days after the original | 6 | | payment is made. No contract between an insurer and a health | 7 | | care professional or health care provider may provide for | 8 | | recoupments in violation of this Section.
| 9 | | (Source: P.A. 93-261, eff. 1-1-04.)
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