Bill Text: IL HB1529 | 2011-2012 | 97th General Assembly | Introduced

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Bill Title: 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.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-01-08 - Session Sine Die [HB1529 Detail]

Download: Illinois-2011-HB1529-Introduced.html

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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
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.
LRB097 09778 RPM 49922 b
A BILL FOR
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AN ACT concerning insurance.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 368d and by adding Section 355.3 as follows:
(215 ILCS 5/355.3 new)
Sec. 355.3. Dental plans; contracting.
(a) Every company that issues, delivers, amends, or renews
any individual or group policy of accident and health insurance
on or after the effective date of this amendatory Act of the
97th General Assembly that provides dental insurance must list
in the fee schedule attached to the contract every American
Dental Association's Code on Dental Procedures and
Nomenclature (CDT) code upon which the plan imposes a capped
fee and the specific dollar amount of the capped fee.
(b) Any CDT code not listed in the contract as prescribed
in subsection (a) of this Section shall not be subject to any
fee cap. In such cases, the provider may balance bill the
patient.
(c) Every company that issues, delivers, amends, or renews
any individual or group policy of accident and health insurance
on or after the effective date of this amendatory Act of the
97th General Assembly that provides dental insurance must

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highlight any changes in subsequent contract terms or
conditions, including changes in reimbursement, and shall have
the original plan administrator notify the enrolled dentist and
allow the dentist sufficient time to review, renegotiate, or
terminate the contract.
(215 ILCS 5/368d)
Sec. 368d. Recoupments.
(a) A health care professional or health care provider
shall be provided a remittance advice, which must include an
explanation of a recoupment or offset taken by an insurer,
health maintenance organization, independent practice
association, or physician hospital organization, if any. The
recoupment explanation shall, at a minimum, include the name of
the patient; the date of service; the service code or if no
service code is available a service description; the recoupment
amount; and the reason for the recoupment or offset. In
addition, an insurer, health maintenance organization,
independent practice association, or physician hospital
organization shall provide with the remittance advice a
telephone number or mailing address to initiate an appeal of
the recoupment or offset.
(b) It is not a recoupment when a health care professional
or health care provider is paid an amount prospectively or
concurrently under a contract with an insurer, health
maintenance organization, independent practice association, or

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physician hospital organization that requires a retrospective
reconciliation based upon specific conditions outlined in the
contract.
(c) No recoupment or offset may be requested or withheld
from future payments 366 or more days after the original
payment is made. No contract between an insurer and a health
care professional or health care provider may provide for
recoupments in violation of this Section.
(Source: P.A. 93-261, eff. 1-1-04.)