The Fair Patient Billing Act standardizes billing and collection practices for all Illinois hospitals. Here are answers to frequently asked questions about out-of-network providers and patient responsibilities and enforcement.
Out-of-Network Providers FAQs
What information must hospitals provide to insured patients about the possibility of being treated by out-of-network providers at the hospital?
Hospitals must provide an insured patient written notice during the admission or as soon as practicable thereafter that:
The patient may receive separate bills for services by healthcare professionals affiliated with the hospital and some who may not be participating providers in the same insurance plans and networks as the hospital;
The patient may have a greater financial responsibility for the services outlined above; and
Questions about coverage or benefit levels should be directed to the patient’s healthcare plan and the patient’s certificate of coverage.
How does this notice requirement differ from the notice hospitals already give under the Insurance Code?
As a practical matter, this requirement is the same as the one required under the Insurance Code. However, the language required under this new law may be more precise and useful for patients.
Does the hospital now have to provide the notice required under the Insurance Code and another virtually identical notice required under this law?
No. The notice required under this new law should satisfy the requirements of both laws.
Patient Responsibilities and Enforcement FAQs
What obligations does the law impose on patients?
In order to receive protections under this law, a patient has two requirements:
Act reasonably and cooperate in good faith by providing the hospital with all reasonably requested financial and other relevant information/documentation needed to determine the patient’s eligibility under the hospital’s financial assistance policy and reasonable payment plan options to the qualified patient within 30 days of request for such information; and
Communicate to the hospital any material change in his/her financial situation that may affect his/her ability to abide by the reasonable payment plan or qualification for financial assistance within 30 days of the change.
Patients who fail to provide reasonably requested information or patients who provide false coverage information are not acting in “good faith” or reasonably. Such patients cannot rely on the billing and collection protections of the law.
How will this law be enforced?
The state Attorney General’s Office will enforce the law, which includes process to handle complaints from individuals or hospitals. The Attorney General may also conduct investigations of possible violations of the law. If the Attorney General has reason to believe there has been a violation, he/she may bring action against the hospital to obtain injunctive relief for any act, policy or practice by the hospital. Before bringing such action, the Attorney General may permit the hospital to submit a correction plan for the Attorney General’s approval. The Attorney General also may seek an assessment of civil monetary penalties.