Insurance Win for Illinois DCs, Other Providers

Illinois Gov. Patrick Quinn has signed H.B. 1193 into law, which amends the Illinois Insurance Code to, among other stipulations, limit the time frame an insurer has to recoup funds from a doctor of chiropractic or other health care provider for claims already paid.

According to the text of the legislation, which takes effect Jan. 1, 2012 and was supported by state provider organizations spanning various health care disciplines, including the Illinois Chiropractic Society, dental and medical associations:

“No recoupment or offset may be requested or withheld from future payments 18 months or more after the original payment is made, except in cases in which: (1) a court, government administrative agency, other tribunal, or independent third-party arbitrator makes or has made a formal finding of fraud or material misrepresentation; (2) an insurer is acting as a plan administrator for the Comprehensive Health Insurance Plan under the Comprehensive Health Insurance Plan Act; or (3) the provider has already been paid in full by any other payer, third party, or workers’ compensation insurer. No contract between an insurer and a health care professional or health care provider may provide for recoupments in violation of this Section.”

By Editorial Staff