“Implants” in Illinois workers’ compensation for $150,000 plus!!! Is anyone at the IWCC listening?
Editor’s comment: After an earlier article about what we thought were wildly high costs for artificial discs, we are now learning of a very strange new pricing practice hitting our defense clients. Turns out anything that is arguably “implanted” as part of a workers’ compensation surgery is being wildly overpriced to the point of gouging. We cannot prove it but our sources tell us the hospitals aren’t billing the same amounts for non-work-related surgeries of precisely the same nature.
We are told the “implant” community fought and lobbied and donated monies to Illinois politicians to keep their products out of the limitations imposed by the Illinois workers’ compensation medical fee schedule. We know our readers are stunned to hear Illinois politicians from the prior administration might actually succumb to such things!! As the implants are not on the schedule, we are seeing bills where less than a pound of screws, cages or rods are now being billed at $100,000-200,000 in costs to Illinois business.
For example, we have a hospital bill for a cervical fusion that is $280,000. It is from a small hospital in southern Illinois. Please note that staggering amount for a surgery that takes about 45 minutes—if you are doing the math that is about $6,200 per minute for a clean, well-lit room and instruments. The surgeon and post-surgical care are all extra.
The bump in costs is the hospital is charging $10,000-20,000 for each “implant” like screws or cages. Please understand the actual cost of a titanium screw is fractionally lower. The only justification for the claimed cost is the absence of such products on the fee schedule and the hospital is willing to accept 76% of the billed cost under Illinois law.
We are battling this and hope we can get an Arbitrator from that area to stop the gouging. We are told many Illinois Arbitrators are hearing more and more complaints about the practice and they are using common sense to stop it. We applaud them for doing so.
But we truly hope the Governor, Illinois Attorney General and the Workers’ Compensation Medical Fee Schedule Advisory Board and that “Commission” itself start to investigate this practice. If the perpetrators are only pricing things in this fashion for workers’ compensation claims, it clearly is gouging Illinois employers and must be administratively stopped. If that isn’t enough to get it to end, we urge our administrators to make recommendations to the legislature to make it end.
We appreciate your thoughts and comments.
