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Illinois delays dental claims

Springfield, Ill.—The dismal economy and a state budget shortfall have left public agencies scrambling to make ends meet, often forcing them to cut services and employees.

The state of Illinois describes it as a “difficult and unprecedented funding situation,” and dentists are also feeling the pinch. The lack of available money has delayed the payment of dental claims for state employees by more than 200 days in some cases, angering Illinois dentists and forcing them to scramble to make their own ends meet.

“I think it’s hard for many of us in Illinois to understand all of the state’s financial situation when we saw a 66 percent increase in income tax, thus creating extra revenue,” said Dr. Chauncey Cross, a dentist in Springfield and chair of the Illinois State Dental Society’s governmental affairs committee. “It seems to many of us the state should be paying its past due bills.”

The state is paying the bills, just very slowly. The State of Illinois Quality Care Dental Plan is self-funded, so claims are paid when money becomes available. Funding comes from legislative appropriations, state revenue and a small amount of employee premiums.

“Funding availability is based on state revenue, which fluctuates from month to month. At this time, funds remain insufficient to pay claims on a normal schedule,” according to the Illinois Department of Central Management Services’ website.

In order to understand the present situation, it’s important to understand the history, said Dr. Cross. The claim lag started more than a year ago when the state got behind on its payments, he said.

After 90 days, the state was required to pay 1 percent in interest, he said. So in many cases, payment was delayed up until that 90-day mark to avoid paying any interest, Dr. Cross said. Claim payments that went past the 90 days weren’t being paid until up to 250 days past when they were processed, he said.

“That creates a problem because many dentists would have to establish a line of credit to pay their bills,” Dr. Cross said. “By delaying payment of claims this long, the state is, in essence, forcing dentists to be lending institutions to their patients. Small businesses like dental offices don’t commonly have the ability to absorb this sort of interruption in their cash flow.”

CompBenefits was the previous plan administrator and is currently paying claims submitted prior to July 1. As of Nov. 2, claims processed through May 11 have been released to providers.

Delta Dental of Illinois took over as administrator July 1 and is paying in-network claims 91 days after they are processed and out-of-network claims 175 days out, said Dionne Haney, director of professional services for the ISDS. Dentists could be paid more than 200 days after they performed services, she said.

The difference in the claim lag between participating and nonparticipating dentists is meant to steer dentists toward participating in the Delta Dental PPO and Delta Dental Premier networks, said Delta spokeswoman Ann Marie Walker. It’s a move Delta says will maximize savings for the state.

“A network-based plan will save the state and enrollees money, as it does for our thousands of other clients, which is why the majority of dental plan designs ‘steer’ enrollees to network dentists,” Ms. Walker said.

“Moving to a network-based plan is expected to help save the state and its employees and their families significant claim dollars,” said Bernie Glossy, president and CEO of Delta Dental of Illinois, in a news release. “Dental networks help make dental care more accessible and affordable to consumers and those employer groups who offer dental benefit programs.”

Late payment interest is now paid to dental providers on claims that take longer than 30 days from the receipt of a complete claim submission to pay, according to the state website. Patients can make arrangements with their dentists to “pay the outstanding balance or establish a payment plan,” according to the state, but the provider should reimburse the patient after they receive payment from CompBenefits or Delta. “It is your responsibility to make reimbursement arrangements with your provider,” according to the state website.

As part of their participation in the dental networks, dentists agree to provide dental services for lower fees and, in turn, have access to a larger patient base, according to the news release.

But that fee cut, which Dr. Cross said is 30 percent, also hurts dentists who are trying to pay the bills.

“I’m not sure how you cut your fees by 30 percent anyway and survive, but that’s my own personal feeling,” Dr. Cross said.

Hank Scheff, director of research and employee benefits for the American Federation of State County and Municipal Employees, the major union that negotiates the benefit plans for Illinois, said the claim lag is the same with Delta Dental as it was with CompBenefits.

“The claim lag is the claim lag,” Mr. Scheff said.

The lack of funding is also not much different than in years past, Mr. Scheff said.

“The state doesn’t have enough money to pay lots of stuff on time,” Mr. Scheff said. “For years, rather than make the appropriate budgetary adjustments, they underfunded things like group insurance and dental and the pension plans of the workers.”