CHICAGO-Illinois lawmakers have repeatedly resisted pressure from employers, labor groups and insurers to ban balance billing of injured workers, but the issue will come up again this session.

Balance billing is the practice of medical care providers billing injured workers for payments in excess of the fee reimbursed by an insurer or self-insuring employer.

The practice is "very controversial," and any proposal to change it should be addressed by the Legislature, said John W. Hallock Jr., chairman of the Illinois Industrial Commission, which oversees the state's workers compensation system. "It is not something we can do in-house."

Nearly every other state bans medical care providers from billing injured workers for such payments, either by law or administrative rule, according to Eric J. Oxfeld, president of UBA Inc., an association representing business interests in Washington.

However, Illinois employers, labor unions and insurers have been unsuccessful in their joint efforts during the past several years to urge legislators to pass such a ban.

The joint effort is unusual. While employers and unions often face off over workers comp reform issues, "this is an issue where business, insurers and workers are aligned with each other," said Sean Stott, legislative director of the AFL-CIO in Springfield, Ill.

"Since 1989, we have tried to solve the problem, but the votes weren't there," said Boro Reljic, vp-government affairs for the Illinois Manufacturers Assn. in Springfield, Ill.

The proponents are expected to again lobby for a ban on balance billing during the Legislature's spring session. The Illinois House will consider the topic during meetings of a new Health Care Access and Affordability Committee, according to a spokesman for Illinois House Speaker Michael Madigan, D-Chicago.

Democrats recently resumed control of the Illinois House after a two-year hiatus that followed a Republican sweep of both houses in 1994 that brought with it support for employer-supported changes like tort reform.

The speaker and House Democrats are "open minded" about a ban on balance billing, though they appreciate that doctors must be paid well enough to ensure they will continue to take injured workers as patients, Mr. Madigan's spokesman said.

However, many observers expect little or no workers comp reform from a Democrat-controlled House, despite labor's support for the ban.

The strength of the medical care providers' lobby is a major stumbling block, spokesmen for business, labor and insurers say.

"Doctors and hospitals balance bill as a way to protect their incomes," said Todd Maisch, director of government affairs for the Illinois State Chamber of Commerce in Springfield.

The medical providers see it a little differently.

In many cases, they are merely seeking fair compensation for the extra time involved with treating an injured worker under workers comp, including discussing treatment issues with a case manager and extra reports, said Dr. E. Richard Blonsky, director of The Pain and Rehabilitation Clinic of Chicago.

The Illinois State Medical Society's position is that medical care and reimbursement for it are part of the doctor-patient relationship. Banning balance billing would effectively leave insurance companies free to impose "a fee schedule" on doctors which may, or may not, reflect the actual cost of care.

Doctors consider insurer-imposed reasonable and customary charges to effectively create a workers compensation fee schedule. Illinois is one of about a dozen states that does not have such a schedule.

Another major stumbling block to banning balance billing has been that such proposals often were packaged by employers and insurers with other managed care measures, such as controls on pro-viders, that would limit injured workers' choice of medical services. Labor unions typically oppose this.

Because Illinois law is silent on the issue of managed care, employers and insurers have tried to develop such programs themselves.

However, effective managed care programs, such as utilization review, are more difficult to establish in Illinois because injured workers are allowed to choose their own medical care providers. As a result, employers have less authority to direct injured workers to seek treatment from specific doctors who have contracted to provide medical care at discounted fees, as they can with non-job-related injuries.

The Illinois Senate is another significant stumbling block to enacting any ban on balance billing.

Illinois Senate President James "Pate" Philip, R-Wood Dale, prefers a 1995 Senate-approved measure that banned balance billing but also restricted a worker's choice of medical provider, among other things. "We thought it was a reasonable compromise," his spokeswoman said.

However, the House last month refused to pass even a diluted version of the bill that excluded the ban.

If completely banning balance billing is not politically feasible, there are some other alternatives.

One would be for the legislature to authorize the Illinois Industrial Commission, which administers the state workers comp system, to establish a separate panel to review the appropriateness of medical treatment and fees in workers comp cases.

The legislature also would have to provide extra money to fund the panel's activities because the commission's nearly $9.2 million budget is too lean to add such a service, said the Industrial Commission's Mr. Hallock.

"I don't know where the Industrial Commission will get its medical expertise" and who would appoint the doctors to the panel, Dr. Blonsky said.

In addition, having medical issues unresolved would make lump sum settlements impossible and keep cases open longer, said George Cullen, an employees attorney with Cullen, Haskins, Nicholson & Menchetti P.C. in Chicago.

Another alternative would be to have employers and workers exercise an option in Illinois law that allows them on a company-by-company basis to jointly choose a panel of doctors who will provide treatment to injured workers, said Robert J. Malooly, who finished his five-year appointment as Industrial Commission chairman in 1995.

"The focus would be on getting good medical treatment for employees and getting them back to the job-not on disputes," said Mr. Malooly, now vp-marketing for Chicago-based U.S. Rating Bureau Inc., a workers comp rating service.

The only company to exercise that option is Excel Corp., a pork processing plant in Beardstown, Ill.

It established a jointly chosen medical panel "to improve the quality of care employees would have available," a spokesman said. The panel of doctors helps the Cargill Inc. subsidiary prevent injuries and encourage timely return to work.

While all employers are not likely to implement that ideal solution soon, there is a small change insurers could make that might improve the situation, suggested Ruth Stelzman, an attorney with her own firm in Chicago.

An insurer should get a release from the doctor that he or she will accept a lesser amount. Or at least the insurer should promptly notify the worker that the insurer has paid a lesser payment, said Ms. Stelzman, president of the Workers Compensation Lawyers' Assn. in Chicago. However, she acknowledged insurers may oppose this because it would increase staff time spent on each case.