Commercial Health Insurance/Managed CareManaged Care is one form of commercial health insurance in Illinois. The growth of managed care highlights the previous response of business to increasing healthcare costs. Although forms of managed care have existed for many years, the decade of the '90s demonstrated a dramatic increase in the number of lives covered by managed care organizations. Managed care is multi-faceted. In reality, different forms of managed care exist along a continuum ranging from tightly managed plans such as Health Maintenance Organizations (HMOs) to more loosely managed plans such as Preferred Provider Organizations (PPOs). In fact, some traditional fee-for-service plans have adopted aspects of managed care to review expenditures. Most recently, consumer driven health plans marketed from an indemnity platform have become the product of choice.Provider organizations feel the impact of managed care in financial areas such as contracting discounts and through operational controls such as utilization review. Managed Care was originally a private payor phenomenon but it has expanded into the public sector in both the Medicare and Medicaid programs. Providers have faced increasing pressure both in a financial sense as well as an increase in the complexity of administration. In the late 90's/early 2000, a consumer "backlash" was observed against managed care. Health care consumers expressed dissatisfaction with increasing controls placed on the delivery of health care including their choice of physician. It took some time for the movement to occur but this backlash resulted in a proliferation of health insurance legislation. State laws govern non-ERISA plans. While State laws related to commercial health insurance may not cover all enrollees within Illinois, legislation still carries significant impact. Providers should specifically be informed regarding the prompt payment law, credentialing law, and the contracting law. You will find relevant information below regarding these laws and other issues regarding commercial health insurance.
Staff Contact: Elena Butkus: (630) 276-5526 | |
| Copyright © 2008 Illinois Hospital Association | |