The Illinois legislature enacted the Fair Patient Billing Act (210 ILCS 88/1 et seq.) (the “Act”) effective January 1, 2007; however, hospitals have until July 1, 2007 to implement the notifi cation, billing and collections policies and procedures required by the Act. The Act applies to all hospitals licensed under the Hospital Licensing Act and its provisions will be enforced by the Illinois Attorney General. The stated purpose of the Act is to advance the prompt and accurate payment of health care services through fair and reasonable billing and collection practices.
The Act imposes obligations upon hospitals in four categories. Specifi cally, hospitals must: (1) notify patients of the availability of fi nancial assistance; (2) include certain information in patient bills; (3) follow certain procedures prior to pursuing collection actions against insured and uninsured patients; and (4) notify patients concerning the costs associated with out-ofnetwork providers. The Act also details certain requirements that patients must comply with to receive the benefi ts and protections under the Act. Each of the above is addressed in more detail below.
Hospitals are required to conspicuously post signage in the admission and registration areas of the hospital to notify patients of the availability of fi nancial assistance. Additionally, the hospital must have information in the form of a brochure, application or other written material available in such areas. Notifi cation of fi nancial assistance, and appropriate applications, must also be posted prominently on the hospital’s website (if the hospital has a website).
Hospital bills to patients must include the following information:
(i) The date or dates service was provided;
(ii) A brief description of the services provided;
(iii) The amount owed for the hospital services;
(iv) Hospital contact information for billing inquiries;
(v) A statement on how uninsured patients may apply for fi nancial assistance; and
(vi) Notice that a patient may request an itemized bill.
Further, all hospital bills must include a telephone number which provides information regarding how a patient can inquire into or dispute a bill. All patient telephone calls must be returned no later than two business days after the call is received. Hospitals may also choose to implement a process which allows patients to inquire or dispute a bill through an e-mail address or website. If the hospital implements such a process, the hospital must respond to correspondence received via the e-mail address or the website within 10 business days of its submission.
Before a hospital may pursue any collection action against a patient, the litigation must be approved in writing by an authorized hospital employee who reasonably believes that the Act’s conditions for pursuing collection actions have been met. Hospitals also must ensure that any collection agency, law fi rm or individual engaged by the hospital to collect outstanding bills has agreed in writing to comply with the Act’s collection provisions.
The Act details requirements for pursuing collection actions against both insured and uninsured individuals. With respect to insured patients, hospitals may not refer a bill for collection without fi rst offering the patient the opportunity to request a reasonable payment plan. However, if an insured patient requests such a payment plan but does not accept it within 30 days of the request, the hospital may proceed with collection action.
With respect to uninsured patients, the Act permits hospitals to pursue collection actions only after giving the patient the following opportunities:
(i) To assess the accuracy of the bill, apply for fi nancial assistance under the hospital’s fi nancial assistance and to avail himself or herself of a reasonable payment plan;
(ii) If the uninsured patient has indicated an inability to pay the full amount of the debt in one payment, the hospital has offered the patient a reasonable payment plan; and
(iii) To the extent the hospital provides fi nancial assistance and the circumstances of the uninsured patient suggest the patient may be eligible for charity care, the uninsured patient has been given at least 60 days following the date of discharge to submit an application for such assistance.
Even then, the Act permits hospitals to pursue legal action against uninsured patients for nonpayment of bills only if the uninsured patient has agreed to a reasonable payment plan and the patient has failed to make agreed-upon payments or the patient has applied for health care coverage under a government-sponsored health care program and the application for government benefi ts is denied. Further, the Act prohibits hospitals from pursuing legal action for nonpayment of a hospital bill against an uninsured patient who has clearly demonstrated that he or she does not have suffi cient income or assets to meet the patient’s fi nancial obligations, provided that the patient has complied with the patient responsibilities under the Act.
Out-of-Network Provider Charges
Hospitals must provide insured patients with written notice at the time of admission or as soon as practical thereafter that:
(i) The patient may receive separate bills for services provided by professionals affi liated with the hospital;
(ii) If applicable, some hospital staff members may not be participating providers in the same insurance plan as the network of the hospital;
(iii) If applicable, the patient may have a greater fi nancial responsibility for services from those who are not under contract with the patient’s health care plan; and
(iv) Questions about coverage should be directed to the patient’s health care plan.
Finally, the Act’s protections and benefi ts are limited to patients who act reasonably and cooperate in good faith by providing the hospital with all requested fi nancial and other relevant documentation needed to determine eligibility for fi nancial assistance.
The Act requires patients to produce the requested fi nancial information and documents within 30 days. Patients also must notify the hospital of any changes in their fi nancial situation that may affect their ability to pay or comply with the terms of any agreed-to payment plan within 30 days of the change.