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Illinois adopts consumer protection law regarding health insurance claims

Posted On Thu, December 31, 2009

Beginning in July, a new bill signed into law on Tuesday will allow Illinois residents greater protection regarding insurance claims that are initially denied by their provider.

Under the new legislation, state residents who have their health insurance claim denied by an insurer will have an opportunity to submit it for an external review that will conducted by independent doctors who have been pre-approved by " a nationally-accredited and Illinois Department of Insurance-approved Independent Review Organization."

The results of the review will be binding and must be completed within 20 business days, with urgent cases receiving expedited reviews that are completed within 72 to 120 hours.

The current laws only allow for residents who are enrolled in an HMO to be granted an independent and external review if their claim is denied.

"This important consumer protection legislation will improve health insurance in Illinois and help people fight back when claims are unfairly denied,” said Governor Pat Quinn, who signed the law into effect. "This new law guarantees the right to an independent review of denied claims for everyone with health insurance in Illinois."

Additionally, the new legislation will require insurance providers that cover small businesses to accept a standard insurance application by January 1, 2011, simplifying the process for businesses that do not have a human relations department.

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