An important role of the ICS is to advocate for legislation that helps the chiropractic profession to provide patients with accessible, affordable health care. One way to achieve this goal is to make certain that health insurers fairly evaluate and pay claims of their insureds.
The recent Health Carrier External Review Act does just that by allowing patients to request an external review of health insurance claim denials. This means that patients may obtain reviews from independent review organizations (IROs) that will, by definition, review coverage decisions impartially, having no financial interest in the outcome. The law applies to all health insurers and HMOs and went into effect on July 1, 2010, providing oversight of claim denials for persons who are covered by commercial health insurance and HMO plans. Illinois residents who are covered by a union or self-funded health plans are still not entitled to independent, external claims review unless it is voluntarily provided because union and employer health plans are governed by the federal ERISA law that requires only an internal claims review. Nonetheless, the Health Carrier External Review Act legislation is a significant reform in Illinois insurance law that will greatly expand the number of Illinois residents who will now have the right to an external review.
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