Illinois Mandates Health Care Claim Review

Patients now can appeal denials to a state-approved nationally accredited independent review organization. The review will be binding and must be completed within 20 business days. In some urgent cases, the review must be completed within 72 to 120 hours.

H.B. 3923 also requires health insurers operating in Illinois to give the state data on how much they receive in premiums and what percentage of those premiums is spent to pay claims and health care costs versus covering administrative costs. The Illinois Department of Insurance will post the data online, officials say.

Also under the new law, insurers that cover small businesses must accept a standard insurance application by Jan. 1, 2011. Applicants for individual health insurance will also be able to use a standard application.

Advocates of the standard application requirement are hoping it will help individuals and small groups to shop around for the best coverage, by eliminating the need to fill out a new form for each carrier.