How Much Are You Paying For Medical Implants?

When the Medical Fee Schedule for the Illinois Workers’ Compensation Act was implemented in 2006, medical implants were to be paid for at 65% of charge for the device. These devices include everything from BAK cages used in spinal fusions, screws and plates used to repair fractures, surgical implants for arthroplasty procedures and a multitude of other surgical devices too long to list.

As one might expect, without any limit on what can be charged for these devices, this provision hardly provided any limitation on the costs of these devices. (There have been reports of charges by medical facilities exceeded 300% of the cost of a device.) On July 6, 2010, an emergency rule was put into effect by the Illinois Workers’ Compensation Commission setting a new limit on the costs for these devices to employers and carriers of invoice cost to the provider, less any rebates received by the provider, plus 25%.

What this essentially means is that it was agreed that the medical providers should be entitled to some “mark-up” for the devices, but this was going to be capped at 25% of what the provider paid for the device. Do not understand this? Well, never mind, because on October 28, 2010, JCAR (Joint Committee on Administrative Rules), the persons responsible for approving emergency rules and permanent rules, repealed this emergency rule and denied to implement the corresponding and similar permanent rule in favor of the Illinois Hospital Association and labor groups who have opposed this rule. Thus, employers and carriers will need to continue paying “65% of charge” for surgical implants.

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