Springfield, Illinois—Legislation to overhaul the appeal process of health insurance claims was signed into law this week. One of the legislation’s sponsors State Senator Dale Righter (R-Mattoon) explained that the legislation now mandates that all Illinois regulated health insurance policies will now have uniform processes for internal and external appeals to a health insurance claim.

The newly signed legislation creates an internal and an independent external appeals process substantially similar to the National Association of Insurance Commissioners (NAIC) model legislation. Current Illinois law only requires an HMO health plan to provide internal or external appeals. While many health insurers provide an internal and an external appeals process, this new law assures that all Illinois-regulated health plans will meet NAIC uniform standards for providing such processes.

“Clearly, every patient should have the right to an appeal process for their health insurance regardless of if they are a part of an HMO or not,” said Senator Righter. “And to the industry’s credit, it recognizes that. This legislation calls for a swift, thorough process of appeals, both internal and external, for all Illinois regulated health plans.”

According to Senator Righter, the passage of this legislation was a bi-partisan effort.  He worked closely with sponsor State Senator Heather Steans (D- Chicago) to ensure that the legislation was truly encompassed all areas necessary to ensure that no patients would be left out of the appeals process.

“When you have leadership that is determined for a fair and balanced process, the system improves,” stated Senator Righter. “This bill is a great example of that principle.” 

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