SB 2379

Abstract

Amends the Illinois Insurance Code. Provides that on and after the effective date of the amendatory Act, no insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in this State providing coverage for hospital or any other health care service shall use extrapolation or any other form of statistical sampling methodology to recoup payments for services rendered by any health care professional or provider. Provides that the use of extrapolation or any other form of statistical sampling methodology is an unfair and deceptive act under the Code. Requires any request for recoupment or offset be in writing and include every contested Current Procedural Terminology code and patient encounter data. Requires a minimum of 120 days after the information is provided to respond to requests for recoupment and offsets. Provides that no recoupment or offset may be made unless the provisions are complied with. Provides that the provisions may be enforced by a health care professional or provider through a court of competent jurisdiction or through mandatory arbitration with the right to recover attorney's fees. Makes similar changes in the Managed Care Reform and Patient Rights Act for health care plans. Amends the State Employees Group Insurance Act of 1971, Counties Code, Illinois Municipal Code, School Code, Health Maintenance Organization Act, Limited Health Service Organization Act, Voluntary Health Services Plans Act, and Illinois Public Aid Code to make conforming changes.