093_SB1776

 
                                     LRB093 03728 JLS 03758 b

 1        AN ACT concerning insurance.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  5.  The  Illinois  Insurance  Code is amended by
 5    adding Section 368e as follows:

 6        (215 ILCS 5/368e new)
 7        Sec. 368e.  Recoupments. Any attempt to  recoup  payments
 8    shall  be initiated by providing a written explanation of any
 9    proposed recoupment, including, but not limited to, the  name
10    of  the  patient,  the date of service, the service code, and
11    the payment amount, the details concerning  the  reasons  for
12    the  recoupment,  and an explanation of the appeal process. A
13    health care professional or health  care  provider  shall  be
14    given  60  days to appeal the proposed recoupment or to repay
15    the  recoupment  amount.  If  the  professional  or  provider
16    chooses to appeal the proposed recoupment and,  upon  appeal,
17    the  proposed recoupment is determined to be appropriate, the
18    professional or provider must pay the  recoupment  within  30
19    days  of receiving the notice of the final appeal's decision.
20    If the professional or provider does not  make  any  required
21    recoupment  payment within these time frames, the company may
22    offset future payments to effectuate the recoupment.   Except
23    in  an  instance  in  which  the  health care professional or
24    health care provider has  been  found  guilty  of  committing
25    civil  or  criminal  insurance  fraud,  no  recoupment of any
26    payments may be initiated 24 months after the date the moneys
27    were paid.

28        Section 99. Effective date.  This  Act  takes  effect  on
29    December 1, 2003.