100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB5776

 

Introduced , by Rep. Sam Yingling

 

SYNOPSIS AS INTRODUCED:
 
770 ILCS 23/5
770 ILCS 23/10
770 ILCS 23/45

    Amends the Health Care Services Lien Act. Provides that "health care benefit plan" means an insurance plan provided by any public or private medical insurance provider. Adds procedures requiring a health care professional or health care provider to submit all charges to the patient's health care benefit plan prior to filing the notice of the lien. Provides that the patient's health care benefit plan shall not deny payment on the basis that a third party or other insurance carrier is responsible for the patient's injuries. Provides that the amount of the lien shall be limited to the amount the health care professional or the health care provider would have received if the charges were covered by the patient's health care benefit plan. Adds provisions concerning health care benefit plan subrogation claims. Provides that a health care professional or a health care provider that recovers under a judgment, verdict, or settlement is responsible for the pro rata share of the legal and administrative expenses incurred in obtaining the judgment, verdict, or settlement. Makes other changes.


LRB100 19718 HEP 34992 b

 

 

A BILL FOR

 

HB5776LRB100 19718 HEP 34992 b

1    AN ACT concerning civil law.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Health Care Services Lien Act is amended by
5changing Sections 5, 10, and 45 as follows:
 
6    (770 ILCS 23/5)
7    Sec. 5. Definitions. In this Act:
8    "Health care professional" means any individual in any of
9the following license categories: licensed physician, licensed
10dentist, licensed optometrist, licensed naprapath, licensed
11clinical psychologist, or licensed physical therapist.
12    "Health care provider" means any entity in any of the
13following license categories: licensed hospital, licensed home
14health agency, licensed ambulatory surgical treatment center,
15licensed long-term care facilities, or licensed emergency
16medical services personnel.
17    "Health care benefit plan" mean an insurance plan provided
18by any public or private medical insurance provider.
19    This amendatory Act of the 94th General Assembly applies to
20causes of action accruing on or after its effective date.
21(Source: P.A. 93-51, eff. 7-1-03; 94-403, eff. 1-1-06.)
 
22    (770 ILCS 23/10)

 

 

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1    Sec. 10. Lien created; limitation.
2    (a) Every health care professional and health care provider
3that renders any service in the treatment, care, or maintenance
4of an injured person, except services rendered under the
5provisions of the Workers' Compensation Act or the Workers'
6Occupational Diseases Act, shall have a lien upon all claims
7and causes of action of the injured person for the amount of
8the health care professional's or health care provider's
9reasonable charges up to the date of payment of damages to the
10injured person. The total amount of all liens under this Act,
11however, shall not exceed 40% of the verdict, judgment, award,
12settlement, or compromise secured by or on behalf of the
13injured person on his or her claim or right of action.
14    (b) The lien shall include a written notice containing the
15name and address of the injured person, the date of the injury,
16the name and address of the health care professional or health
17care provider, and the name of the party alleged to be liable
18to make compensation to the injured person for the injuries
19received. The lien notice shall be served on both the injured
20person and the party against whom the claim or right of action
21exists, but shall not be served on the issuer of an automobile
22or homeowner's insurance policy that provides for medical
23payments. Notwithstanding any other provision of this Act,
24payment in good faith to any person other than the healthcare
25professional or healthcare provider claiming or asserting such
26lien prior to the service of such notice of lien shall, to the

 

 

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1extent of the payment so made, bar or prevent the creation of
2an enforceable lien. Service shall be made by registered or
3certified mail or in person.
4    (b-5) If a patient provides proof of insurance coverage
5under any health care benefit plan within 60 days of treatment
6from a health care professional or health care provider, the
7health care professional or health care provider shall submit
8all charges to the patient's health care benefit plan before
9filing the notice of the lien; the patient's health care
10benefit plan shall not deny payment for the services of either
11the health care professional or health care provider on the
12basis that a third party or another insurance carrier is
13responsible for the payment of the charges for treatment of the
14patient's injuries. If the health care benefit plan denies
15payment for any other reason, the health care benefit plan
16shall provide the health care provider or health care
17professional and the patient with a statement detailing the
18amount the health care benefit plan would have paid for the
19services provided and the amount the patient would have been
20responsible for had the claim not been denied. In such a case,
21the amount of the lien shall be limited to the amount the
22health care professional or the health care provider would have
23received if the charges were covered by the patient's health
24care benefit plan. The failure of a health care benefit plan to
25provide a statement shall not affect the limitations on a lien
26under this Section.

 

 

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1    (b-10) If at any time after to the filing of the notice of
2the lien, a health care professional or a health care provider
3receives health care benefit plan information regarding a
4patient, the health care professional or health care provider
5is not required to withdraw notice of the lien, but shall
6submit the charges for service to the health care benefit plan.
7In such a case, the amount of the lien shall be limited as
8provided in subsection (b-5).
9    (c) All health care professionals and health care providers
10holding liens under this Act with respect to a particular
11injured person shall share proportionate amounts within the
12statutory limitation set forth in subsection (a). The statutory
13limitations under this Section may be waived or otherwise
14reduced only by the lienholder. No individual licensed category
15of health care professional (such as physicians) or health care
16provider (such as hospitals) as set forth in Section 5,
17however, may receive more than one-third of the verdict,
18judgment, award, settlement, or compromise secured by or on
19behalf of the injured person on his or her claim or right of
20action. If the total amount of all liens under this Act meets
21or exceeds 40% of the verdict, judgment, award, settlement, or
22compromise, then:
23        (1) all the liens of health care professionals shall
24    not exceed 20% of the verdict, judgment, award, settlement,
25    or compromise; and
26        (2) all the liens of health care providers shall not

 

 

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1    exceed 20% of the verdict, judgment, award, settlement, or
2    compromise;
3provided, however, that health care services liens shall be
4satisfied to the extent possible for all health care
5professionals and health care providers by reallocating the
6amount unused within the aggregate total limitation of 40% for
7all health care services liens under this Act; and provided
8further that the amounts of liens under paragraphs (1) and (2)
9are subject to the one-third limitation under this subsection.
10     If the total amount of all liens under this Act meets or
11exceeds 40% of the verdict, judgment, award, settlement, or
12compromise, the total amount of all the liens of attorneys
13under the Attorneys Lien Act shall not exceed 30% of the
14verdict, judgment, award, settlement, or compromise. If an
15appeal is taken by any party to a suit based on the claim or
16cause of action, however, the attorney's lien shall not be
17affected or limited by the provisions of this Act.
18    (c-5) If in addition to health care professional liens and
19health care provider liens, there also exist health care
20benefit plan subrogation claims, including those under the
21Medicare Secondary Payer Act and the Illinois Public Aid Code,
22and the existence and inclusion of these subrogation claims in
23addition to the health care services liens exceed 40% of the
24verdict, judgment, award, settlement, or compromise, after
25calculations pursuant to Section 50, then:
26        (1) the liens of the health care professionals shall

 

 

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1    not exceed 10% of the verdict, judgment, award, settlement,
2    or compromise; and
3        (2) the liens of the health care providers shall not
4    exceed 10% of the verdict, judgment, award, settlement, or
5    compromise.
6    Notwithstanding any other provision of this subsection,
7health care services liens shall be satisfied to the extent
8possible for all health care professionals and health care
9providers by reallocating the amount unused within the
10aggregate total limitation of 40% for all health care services
11liens under this Act after satisfaction of health care plan
12subrogation claims, and the amounts of liens under paragraphs
13(1) and (2) are subject to the one-third limitation under this
14subsection.
15    (d) If services furnished by health care professionals and
16health care providers are billed at one all-inclusive rate, the
17total reasonable charges for those services shall be reasonably
18allocated among the health care professionals and health care
19providers and treated as separate liens for purposes of this
20Act, including the filing of separate lien notices. For
21services provided under an all-inclusive rate, the liens of
22health care professionals and health care providers may be
23asserted by the entity that bills the all-inclusive rate.
24    (d-5) A health care professional or a health care provider
25that recovers under a judgment, verdict, or settlement is
26responsible for the pro rata share of the legal and

 

 

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1administrative expenses incurred in obtaining the judgment,
2verdict, or settlement.
3    (e) Payments under the liens shall be made directly to the
4health care professionals and health care providers. For
5services provided under an all-inclusive rate, payments under
6liens shall be made directly to the entity that bills the
7all-inclusive rate.
8(Source: P.A. 93-51, eff. 7-1-03.)
 
9    (770 ILCS 23/45)
10    Sec. 45. Amounts not recovered under lien. Nothing in this
11Act shall be construed as limiting the right of a health care
12professional or health care provider, or attorney, to pursue
13collection, through all available means, of its reasonable
14charges for the services it furnishes to an injured person.
15Notwithstanding any other provision of law, a lien holder may
16seek payment of the amount of its reasonable charges that
17remain not paid after the satisfaction of its lien under this
18Act, except that any bill from a health care professional or
19health care provider must first be reduced by the amount of
20benefits to which the patient is entitled under any contract or
21health care benefit plan and shall reflect all credits,
22adjustments, and write-offs, and the health care provider or
23health care professional may not bill the patient the balance
24of the bill unless it is the responsibility of the patient
25under the health care plan.

 

 

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1(Source: P.A. 93-51, eff. 7-1-03.)