Illinois Governor Signs Consumer Health Claims Review Bill

January 6, 2010

Illinois Governor Pat Quinn has signed a bill into law that ensures that all denied health insurance claims can be reviewed and decided upon by a qualified, independent doctor. The law goes into effect July 1.

Under current state law, only Illinois health insurance consumers who are enrolled in a health maintenance organization (HMO) have the right to an independent, external review when claims are denied. Effective July 1, House Bill 3923 extends the right to an independent review of a denied claim to all Illinois residents with health insurance coverage.

The new law will allow Illinois residents to submit their health insurance claim for an external review after it is denied by their insurer. The external review will be conducted by a qualified, independent doctor, who is selected by a nationally-accredited and Illinois Department of Insurance-approved Independent Review Organization. The external review is binding and must be completed within 20 business days. In certain urgent cases the review must be completed within 72 to 120 hours.

Also under the new law, insurance providers that cover small businesses must accept a standard insurance application by Jan. 1, 2011. This law also applies to individuals who will now be able to use a standard health insurance application.

The standard application will be developed by a committee of consumers, small business owners, insurance agents and insurance company representatives. The committee will work with the Illinois Department of Insurance.

Additionally, House Bill 3923 requires health insurers operating in Illinois to provide the state with how much they receive in premiums and how much of those premiums are spent on paying claims and healthcare costs versus covering administration costs. The Department of Insurance will post this information online to ensure greater accountability among Illinois’ health insurance companies.

House Bill 3923 was sponsored by Rep. Greg Harris (D-Chicago) and Sen. Heather Steans (D-Chicago) and overwhelmingly passed the General Assembly.

Source: Illinois Department of Insurance,

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