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PUT BALANCE BACK IN COMP SYSTEM

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STATE LAWMAKERS need to abolish the practice of balance billing once and for all.

The practice-in which doctors can bill injured workers for medical charges in excess of what employers or insurers pay-represents a serious erosion of the doctrine of exclusive remedy. That doctrine is all that stands between employers and a flood of litigation over worker injuries.

Thankfully, nearly all states ban the practice of balance billing, which begs the question why some have not yet done so.

As we reported Feb. 3, Illinois is one of the few states that does not ban balance billing. Utah permits it as an incentive to use managed care providers for workers comp care. And it is emerging as a problem in the Pacific Northwest in cases where workers cross state lines to seek medical care.

Our biggest concern is that balance billing leaves employees holding the bag for unpaid medical bills-and puts their personal credit at risk. That, in turn, greatly increases the likelihood of lawsuits alleging bad faith handling of workers' claims by employers and their insurers.

Another issue is that allowing doctors an avenue to pursue additional payment erodes the effectiveness of efforts to hold down workers comp medical costs. How can workers comp insurers and employers negotiate lower costs or implement managed care programs when providers can go after employees for the difference?

Doctors in Illinois already charge more for workers comp care on average than providers in many other states.

Illinois' average workers comp medical charges are 89% greater than the state's Medicare fee schedule, according to an analysis by the Workers Compensation Research Institute. Nationwide, the median workers comp fee schedule is 55% greater than Illinois' Medicare fee schedule, the WCRI reports.

Doctors contend a ban on balance billing would let workers comp payers impose a fee schedule that may not reflect the total cost of providing care. We think the WCRI data shows there is plenty of fat in how much providers are charging for workers comp care. It's audacious that a loophole exists allowing doctors to go after employees for even more.

Greed has also been a key reason why the various stakeholders have been unsuccessful in getting a ban passed in Illinois. Employers and insurers in the past pushed for an end to balanced billing as part of broader measures to introduce managed care or limits on workers' choice of providers. Such efforts were opposed by labor.

We think employers, insurers and labor should focus their efforts only on banning balance billing if they are to have any hope of success. For any future efforts at workers comp managed care to succeed, this is a necessary first step.