HB 4789

Abstract

Amends the Illinois Insurance Code. Provides that no insurer, dental service plan corporation, insurance network leasing company, or any company that amends, delivers, issues, or renews an individual or group policy of accident and health insurance that provides dental insurance on or after the effective date of the amendatory Act shall deny any claim subsequently submitted for procedures specifically included in a prior authorization unless certain circumstances apply. Provides that a dental service contractor shall not recoup a claim solely due to a loss of coverage for a patient or ineligibility if, at the time of treatment, the dental service contractor erroneously confirmed coverage and eligibility, but had sufficient information available to the dental service contractor indicating that the patient was no longer covered or was ineligible for coverage. Prohibits waiver of the provisions by contract. House Committee Amendment No. 1 Adds reference to: 215 ILCS 5/355.4 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes. Makes a change in the definition of "prior authorization". Defines "dental carrier" as an insurer, dental service corporation, insurance network leasing company, or any company that offers individual or group policies of accident and health insurance that provide coverage for dental services. Changes references from "dental service contractor" and "insurer" to "dental carrier". Provides that beginning on the effective date of the amendatory Act, a dental carrier shall not deny any claim subsequently submitted for procedures specifically included in a prior authorization unless certain circumstances apply. Removes language providing that no insurer, dental service plan corporation, insurance network leasing company, or any company that amends, delivers, issues, or renews an individual or group policy of accident and health insurance that provides dental insurance on or after the effective date of the amendatory Act shall deny any claim subsequently submitted for procedures specifically included in a prior authorization unless certain circumstances apply. Further amends the Illinois Insurance Code. In a provision requiring contracting entities to provide notification before any scheduled assignment or lease of the network to which the provider is a contracted provider, requires the notification to provide the specific URL address where the following are located: all contract terms, a policy manual, a fee schedule, and a statement that the provider has the right to choose not to participate in third-party access (instead of the notification including all contract terms, a policy manual, a fee schedule, and a statement that the provider has the right to choose not to participate in third-party access). Requires the notification to provide instructions for how the provider may obtain a copy of those materials. Amends the Limited Health Service Organization Act and Voluntary Health Services Plans Act to make conforming changes. Senate Committee Amendment No. 1 Provides that any contractual agreement entered into or amended, delivered, issued, or renewed on or after the effective date of the amendatory Act that is in conflict with the provisions (instead of any contractual agreement that is in conflict with the provisions) or that purports to waive any requirement of the provisions is null and void.