3-9-12; Ouch!! Northwestern Memorial Hospital gets hit with WC “balance billing” class action

We knew it had to happen. Balance billing in the workers’ compensation arena was outlawed in this state in 2005-6 when Section 8a.2 was added to our IL WC Act. Effectively what happens is doctors/hospitals charge “sticker price” for medical care but are willing to routinely accept less for their services, just like car dealers do. The problem arises when the discounts aren’t honored and medical bills for the discounted amounts continue to be sent. The doctor or hospital is “billing” the “balance” they agreed to take as a discount.

When “balance bills” are received by injured workers, lots of confused consumers along with the respective workers’ comp insurers and TPA’s may pay medical bills they don't actually owe. Typically this occurs when WC insurance offers or pays discounted values that are less than what a doctor, hospital, or lab service initially sought to be paid. The health-care provider may repeatedly demand the balance from the innocent patient. On some occasions, in response to penalty and fee petitions, WC adjusters or injured workers may pay up.

“Balance billing” is illegal but one odd aspect of the changes to our IL WC Act in 2005-6 is they didn’t provide any statutory penalty for the practice.. When doctors or hospitals assert a WC insurer has reimbursed too little, Illinois law bars the medical providers from pressuring injured workers to pay the difference. Instead, doctors and hospitals should be directing their concerns to the insurers/TPA’s and leave the patient out of the loop. Economists and patient advocates estimate consumers pay $1 billion or more a year for which they're not responsible.

Our readers and clients ask us all the time what to do about balance bills—how do you best handle them; particularly when you have told the provider repeatedly to stop vexing the injured worker when an appropriate amount has been paid. Well, we have a form letter we can send to such providers to ask them to stand down and stop the prohibited practice. There is always the specter of litigation to stop balance billing practices.

Today, we saw a lawsuit filed in the Circuit Court of Cook County, Chancery Department titled Margaret Kruse v. Northwestern Memorial Hospital, 12 CH 7786, filed March 2, 2012 in which Plaintiffs are seeking class certification and substantial damages against Illinois’ largest hospital. Plaintiffs are specifically complaining of the fact compensable workers’ compensation medical bills are paid under the Illinois Medical Fee Schedule but Northwestern Memorial Hospital continues to send bills for the balances, then forwards the allegedly unpaid billing to bill collectors to dun the injured workers and finally initiates legal action to obtain payment of bills that are not due.

We have no idea and therefore cannot comment on the merits of the claim but we do feel it is important for our readers to know it is out there. We appreciate your thoughts and comments.