FOR IMMEDIATE RELEASE
4/21/2016
FOR INFORMATION, CONTACT:
John Maszinski
Office: 312-580-6440
E-mail:johnmaszinski@isms.org
HB 6562 Will Set New Standard for Health Insurance Networks in Illinois
Networks must be adequate, accessible, and transparent to patients.

Chicago, IL - The Illinois State Medical Society (ISMS) applauds legislation introduced today to protect Illinois patients by establishing standards for adequacy, accessibility and transparency of all health insurance plans sold in Illinois.

H.B. 6562, the Network Adequacy and Transparency Act, introduced by Rep. Greg Harris (D-Chicago) and Rep. Chad Hays (R-Catlin), will require health insurers to develop networks of health professionals, hospitals and facilities that meet the needs of the patients enrolled in their insurance plans. It will also require insurers to maintain up-to-date directories of in-network professionals and facilities, and communicate with patients about changes to their networks. State Sen. Linda Holmes (D-Aurora) will carry the bill in the Senate.

"Patients shopping for health insurance shouldn't have to worry about whether any given network will include enough doctors, or whether the network might change without warning," said ISMS President Thomas M. Anderson, MD. "This bill makes it easier for patients to find a primary care physician or specialist within their network, without spending hours on the phone or on the road. It also protects them when an insurer dramatically reduces networks, often to the detriment of patients." H.B. 6562 also protects those who have had the same insurance for years, ensuring continuity of care even when their preferred physician is no longer in-network. "This legislation will help protect pregnant moms, families whose kids need highly specialized care, and people undergoing treatment for severe conditions like cancer from suddenly losing their doctor on short notice and having to scramble just because insurance companies decided to drop or limit providers," said Rep. Harris. 

"Living in a rural area shouldn't prevent you from having access to top-quality health care," added Rep. Hays. "Gaps in health plan networks mean patients can get stuck driving for hours to get the care they need. We're putting a stop to that. It's up to the insurance company offering coverage in an area to meet their obligations to patients by maintaining a robust provider network."

Insurance companies will be required to file specific information with the Illinois Department of Insurance before marketing any health plan, including details about the professionals and institutions covered by the plan, the ratio of health care professionals to plan beneficiaries, procedures for ensuring beneficiary access to care if not enough in-network professionals are available, and more.

"This consumer-driven legislation will establish important protections for patients when they lose access to their physician by no fault of their own," said Sen. Holmes. "Patients, particularly those with medically complex or life-threatening conditions should not have to worry about interruptions in their care."

"The people of Illinois deserve to know what they're getting when they buy health insurance, and to know that they're going to be able to get the care they need when they're sick," concluded Dr. Anderson. "ISMS is proud to support the Network Adequacy and Transparency Act, and congratulates its sponsors for their strong bipartisan effort to protect Illinois patients."

This legislation is also supported by the American Cancer Society Cancer Action Network and EverThrive. 

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Founded in 1840, ISMS is a professional membership association representing Illinois physicians in all medical specialties, and their patients, statewide. Dr. Anderson practices radiology in Chicago.


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