CHICAGO, July 12, 2011 /PRNewswire/ -- Hospital-based pathology groups and physicians in Illinois filed a federal lawsuit on June 24, 2011, seeking to invalidate, on constitutional grounds, Illinois legislation designed to shift the burden of absorbing certain patient-related costs from insurers to practitioners of only a few specifically-enumerated medical specialties.
The Statute: Illinois Public Act 96-1523
Illinois Public Act 96-1523, took effect June 1, 2011. It amended portions of the Illinois Insurance Act (changing 215 ILCS 5/356z.3 and adding 215 ILCS 5/356z.3a) in such a way as to fundamentally alter the relationships between certain physicians, their patients, and third-party payors such as insurers.
The statute prohibits an inexplicably singled-out group of out-of-network physician-providers from billing insured patients for anything other than the applicable deductible/co-pay that would apply if the provider were an in-network provider for that patient. According to the statute, the provider must seek any remaining amount due from the patient's insurer. In the event of a dispute as to the amount the insurer will pay, the statute mandates binding arbitration at the election of either the insurer or the physician. By its terms, the statute applies to only those physicians or other providers who provide radiology, anesthesiology, pathology, neonatology, or emergency department services to insureds, beneficiaries, or enrollees in a participating facility or participating ambulatory surgical treatment center.
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