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Injured, Insured, but not Protected

The Illinois Health Care Services Lien Act can complicate situations that involve injured patients, their insurance policies, hospital bills, and settlements. In November’s Illinois Bar Journal, Belleville attorney Daniel C. Katzman, who practices in the areas of personal injury, wrongful death, and medical/nursing home malpractice, provides an analysis of common scenarios involving the Lien Act and strategies for attorneys to pursue their injured client’s best interests.

For example, the Lien Act does not require health-care providers to bill health-insurance companies. But providers may do so through a contract known as a provider agreement. The terms of provider agreements are negotiated by the parties and can vary on a case-to-case basis. In a provider agreement, a health-care provider agrees to accept full payment from a health-insurance company for any covered service rendered to the company's insured. While the provider may receive pennies on the dollar in reimbursement, provider agreements benefit both parties in the form of reduced rates in exchange for increased patient volume. When evaluating a health-care provider's obligations, an attorney should examine the provider agreement to determine whether a health-care provider is required to bill the health-insurance company.

Read more in the November issue of the Illinois Bar Journal.

Posted on November 19, 2018 by Rhys Saunders
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