Illinois medical bill assistance programs, provider billing laws, and the statute of limitations help many patients with their finances.
However, if your household income exceeds the federal poverty level, or you do not fit into a protected class, you could wind up owing a tidy sum of money.
I will be difficult to make the problem go away.
Follow this three-part outline for possible avenues of help with unpaid hospital and doctor bills.
- Financial assistance applications for high and low-income families
- Debt collections laws such as the statute of limitations
- Hospital and doctor billing regulations that may reduce what you owe
Illinois Medical Assistance Applications
Finding the correct medical assistance application in Illinois is often quite tricky. The eligibility criteria for the state government program often exclude many men, young adults without children, and families with incomes above the federal poverty level.
People ineligible for the government entitlements often need to complete alternative applications. Choose the option that best fits your needs.
Medical Loan Request
Do you meet personal loan requirements? Borrowed funding is one option to help pay off any unpaid doctor, dentist, or hospital bills before they reach a collection agency. Take this step before a collection account appears on your credit report. This negative mark will hurt your rating, and make it difficult to qualify for a mortgage or car financing in the future.
Repay the lender in monthly installments. Make certain that you a physically able to work and have an ongoing source of income before taking the final step to complete and sign the official loan application.
Debt Relief Application
A debt relief application is another alternative. Illinois residents who do not qualify for Medicaid and other government entitlements may find that a private settlement program offers a better long-term result.
This option works best for people suffering true financial hardship, someone unable to stay current on regular expenses. You must owe more than $10,000 in unsecured obligations to qualify. Unsecured debt includes personal loans, credit card balances, and unpaid medical bills.
Medical Insurance Assistance
Buy a health insurance plan if your family earns too much money to qualify for Medicaid. As of 2017, the federal government still provides private medical insurance financial assistance. Families with incomes up to 400% of the federal poverty level qualify for this help.
- Premium subsidies reduce the monthly cost of the private health insurance
- Cost-sharing subsidies reduce out-of-pocket costs from deductibles and copayments
A licensed agent can help you submit an application through the Illinois health insurance exchange. Residents losing health insurance can enroll any time of the year. The loss of coverage is a qualifying life event triggering a special enrollment period.
Others must wait for the annual open enrollment, which begins in mid-November.
The Illinois Medical Assistance Program1 is one local name for the federal and state government Medicaid entitlement. Many applicants can obtain coverage three months retroactively. This could help with any existing doctor, dental and hospital bills – if eligible.
The Department of Healthcare and Family Services2 administers the rather confusing suite of services. The department offers a broad array of programs with various names and unique target populations, eligibility criteria, and funding sources. Consult the government website for a comprehensive overview. You may need help from a social worker to figure it all out.
Most qualified residents complete an application for benefits at a local Family Community Resource Center. Applicants must fit into one of these three protected class categories, along with meeting income guidelines based on the federal poverty level.
- Blind, disabled, age 65 or older
- Have children under the age of 19
- Pregnant women
Other protected classes of residents can apply for specialized medical assistance benefits.
- Women with breast and cervical cancer
- Workers with disabilities
- People with hemophilia
- Renal dialysis patients
- Sexual assault survivors
- Honorably discharged veterans
- Torture victims and asylum seekers
The Illinois Medical Card benefits include most medically necessary procedures across all programs. Other covered services have more complex rules and requirements.
- Dental care
- Prescription drug coverage
- Eyeglasses and vision care
Medical Debt Collection Laws in Illinois
Medical debt collection laws in Illinois specify time-barred legal defenses, and other rights and responsibilities of consumers. Unfortunately, nothing in any of these laws makes the problem go away.
Disclaimer – the following does not constitute legal or professional advice.
Consult an attorney licensed in Illinois.
Follow the footnoted links for the precise legal language.
Family Medical Leave Act
The Family Medical Leave Act (FMLA) provides unpaid job protections and continued access to health insurance benefits for employees who must stop working. The legal protections last for 12 weeks for covered workers. FMLA covers approximately 40% of workers nationwide.
This law intersects with medical debt collections when workers lose or change insurance coverage while on a leave of absence. Confusion often arises as to the responsible party.
Statute of Limitations
The Statute of Limitations (SOL) on unpaid medical bills in Illinois does not always work the way consumers hope. The length of time could be 5 or 10 years, and the start time can reset. In addition, the law does not stop creditors from pursuing the debt.
5 or 10 Years
The Illinois statute of limitations is 5 years for oral contracts and 10 years for written contracts. Medical debt could fall into either category.
Dentists, doctors, and hospitals frequently require a signed patient financial responsibility agreement before providing services. The existence of such a document and the specific terms contained in it dictate whether the contract is oral or written.
Consult an attorney when in doubt.
The statute of limitations clock on unpaid medical bills starts ticking on the date of last activity. The date of last activity could be the treatment date, the last day the individual made payment or the last day the person acknowledged responsibility.
This means that a person who makes a payment or acknowledges the obligation can reset the limitation years after treatment. Be careful.
The statute of limitations on medical debt provides patients a legal defense against lawsuits by collection agencies or hospitals. The agency can win a lawsuit after the SOL expires if the debtor fails to appear in court and assert this defense. In addition, the law does not prevent collection agencies from pursuing the debt. You still owe the money.
Fair Debt Collection Practices Act
The Fair Debt Collection Practices Act3 is a federal law, which prohibits abusive, unfair, or deceptive practices by collection agencies. The law applies in Illinois and across the nation.
A medical debt collector cannot communicate information with any other person or a third party other than the consumer, his attorney, or a consumer-reporting agency.
The debt collector must follow these rules and others.
- Cannot contact you at inconvenient times or places
- Must send a written validation notice
- May not harass or make false statements
Spousal Responsibility after Death
In Illinois, the surviving spouse is responsible for any medical debts incurred by the deceased partner. For example, a surviving wife is responsible for paying for her husband’s medical bills after his death.
The Rights of Married Persons Act 750 ILCS 65/154 holds that the husband and wife are responsible for the expenses of the family. This marital property law means that the obligation remains after one spouse passes away.
Illinois Medical Billing Laws and Regulations
Several Illinois medical billing laws and regulations protect patient rights – to a point. The healthcare industry is the only one where consumers buy services before learning about the costs. In addition, the amounts charged are often extremely large and often unaffordable.
Balance Billing Act
The Illinois Balance Billing Act (215 ILCS 5/356z.3a)5 limits financial exposure to non-participating facility-based physicians and providers. Facility-based provider means a physician or other professional who provide radiology, anesthesiology, pathology, neonatology, or emergency department services in a participating hospital or ambulatory surgical treatment center.
In the past, a patient could enter an in-network hospital only to receive treatment from an out-of-network subcontractor. After treatment, the consumer would receive a very large surprise balance bill with out-of-network charges.
Under the Balance Billing Act, the health insurance plan must ensure that the patient does not incur greater out-of-pocket costs than he or she would have incurred with a participating provider.
Fair Patient Billing Act
The Illinois Fair Patient Billing Act of 2007 (210 ILCS 88/)6 regulates the fair and reasonable billing and collection practices of hospitals. The state law articulates standards for hospital billing departments to follow.
- Provide sufficient billing information in order to determine the accuracy
- Offer a reasonable opportunity to discuss the accuracy of bills
- Provide information about financial assistance options and qualifications
- Offer the opportunity to enroll in a reasonable payment plan
- Employ responsible standards when collecting debt
Consumers have an obligation to pay for the hospital services they receive.
Uninsured Patient Discounts
The Illinois Uninsured Hospital Discount Act (210 ILCS 89/)7 requires providers to reduce charges for patients meeting specific eligibility criteria. The state law stipulates the discount calculations and other key definitions.
- An uninsured person is someone without third-party coverage
- High deductible plans count as coverage
- Consumers must apply for the discount within 60 days of discharge
- The hospital cannot collect more than 25% of the patient’s annual gross family income
- Charges cannot exceed 135% of the cost of services
- The person must be a resident of Illinois
- Patients must meet family income and asset limits
- 300% of the federal poverty level for urban centers
- 600% of the federal poverty level for rural and critical access centers
Medical Lien Act
The Illinois Healthcare Services Lien Act (770 ILCS 23)8 addresses the amount of money a medical provider can claim after the settlement of a personal injury case. These are the paraphrased basics. Consult an attorney for legal advice.
- Health care providers and professionals cannot place liens totaling more than 40% of the legal award. The providers will share the award proportionately.
- Total liens of the attorneys on the case shall not exceed 30% of the award.
- The injured party receives the remainder of the legal settlement.
- Medical Assistance Program
- HFS Healthcare Programs
- Fair Debt Collections Practices Act
- Rights of Married Persons Act
- Balance Billing Act
- Fair Patient Billing Act
- Uninsured Patient Discounts
- Healthcare Service Lien Act