IDOT retiree figured insurance covered wife’s surgery. Then they got the letter.

Susan Preis and her husband Lee, Okawville retirees living on a fixed income, didn’t think twice about her recent cataract surgery.

Then the letter came.

“Our records indicate your current balance is $6,127.28,” it said.

But it wasn’t a bill, according to the medical provider — it was simply a request for an optional payment.

To Susan Preis, there didn’t appear to be anything optional about it.

“We thought it was a bill that they were wanting us to pay,” she said.

Susan Preis had figured the payment for the surgery would be handled by HealthLink, an Illinois corporation that organizes insurance plans for state workers. The Preises have coverage through his retirement from the Illinois Department of Transportation.

The bill, from the Marion Eye Center, where Susan Preis had her surgery, was sent to 1,600 people, according to general manager Scherrie Eastwood. Despite its language, however, the letter was more of a reminder of what the state owes the business, Eastwood said.

Essentially, it’s an optional bill, but if patients pay anything, they will get the money back whenever the state pays the Marion Eye Center, Eastwood said, adding that the letters were followed up with calls to explain whether patients understood.

“We have been paying our portion,” Susan Preis said, referring to the monthly premiums drawn from the couple’s checking account.

But Illinois isn’t holding up its end of the bargain, even after the General Assembly in June passed a stopgap budget that was meant to help clear some of the nearly $8 billion in unpaid vouchers that piled up during the state’s yearlong budget impasse. Comptroller Leslie Geiger Munger announced on July 14 that she projects that will balloon to $10 billion.

According to a state forecasting report published in July, “As of the end of June, approximately $3.34 billion in claims were being held by the state from various insurers, organizations and companies” for a total of 574 days. HealthLink alone had $627 million in back claims that were stalled 547 days.

Eastwood said the state owes her company’s three dozen physicians and optometrists about $800,000.

“They’re well over a year behind in paying us,” she said. “A small business can’t survive (like that).”

Although Illinois can drag its feet in paying its bills, the Marion Eye Center has to meet its obligations to vendors within 30 days, Eastwood said.

Illinois says it owes the Eye Center’s service providers $520,000, or 35 percent less than the eye center says, according to Meredith Krantz, a spokeswoman for the state’s Central Management Services.

Krantz blamed the issue on “decades of fiscal mismanagement.” Before the budget impasse, provider payments were eight months overdue, climbing to 17 months before the stopgap budget recently approved by the General Assembly, Krantz wrote in an email. But, she pointed out, the temporary budget didn’t fully fund the state insurance system.

“We are currently working with state health plan carriers to schedule the release of applicable claim payments,” she wrote.

Above everything, Eastwood wanted to remind people that the Marion Eye Center will not turn anyone away even if their state insurance provider is not paying claims.

“We just want them to understand where we’re coming from,” she said. Many patients who have health insurance through the state do understand, she said, and although some patients were surprised to get the letters, others also said it wasn’t the first time they’d gotten such a letter from a health provider.

Eastwood said that patients who do pay anything toward their bill will be reimbursed by Marion Eye Center when it gets paid by Illinois. Not every state plan has been affected by the ongoing budget issues, Eastwood said.

HealthLink is upset that the Marion Eye Center sent out the bill in the first place.

“The only payment that should be requested upfront from members is copays, coinsurance, deductibles, and payment for non-covered services,” Deb Wiethop, HealthLink’s public relations director, wrote in an email. “Doctors should not request full payment from members before service, and members should not pay the full cost of service upfront with the intention of getting reimbursed later.”

Weithop said the contract does not allow the Eye Center to send bills to the patients, but Eastwood said her company couldn’t find that stipulation in its contract, which she said she couldn’t disclose.

“They talked to us,” Wiethop, of HealthLink, said of the Eye Center, “and whenever possible, when funding’s available, we would work with them.” She did not give examples of when HealthLink has similarly worked with other clinics or hospitals in the past.

Susan Preis said she didn’t fault the Eye Center. In fact, she sympathized with it. She worked in medical billing trying to get insurance companies to pay claims for 15 years, so she understands “the hoops,” she said.

Preis said she is angrier with the state of Illinois than anyone else. The uncertainty and lack of agreement between doctors and insurers troubles her. She didn’t even know the state had stopped paying the Eye Center.

“(It’s) just like the car stuff,” she said, criticizing Illinois’s decision in February not to inform people about getting their vehicles’ emissions checked. “They don’t let anyone know until it’s so darn late to the party.”

This story was originally published August 20, 2016 at 8:51 AM with the headline "IDOT retiree figured insurance covered wife’s surgery. Then they got the letter.."