Payment issues with health insurance companies continue to cause headaches for physicians and their practices. Delays in payment to physicians threaten the economic sustainability for their practices, especially during an unprecedented pandemic.

Access to quality patient care is often disrupted due to delays from health insurance companies that ultimately threaten the care Illinois patients’ need. ISMS has worked to streamline onerous prior authorization requests and ensure transparency from insurance companies.

ISMS has worked to address numerous health insurance related issues, including but not limited to:

  • Network Adequacy & Transparency Act: ISMS crafted law which ensures the adequacy, accessibility and transparency of health care network plans.
  • Prevented Prescription Drug Formulary Disruptions: ISMS helped enact legislation that will prevent insurance companies from modifying an enrollee’s drug formulary coverage after the enrollee is already locked into a health plan for the year.
  • Right-to-Shop: ISMS blocked legislation that would encourage patients to focus exclusively on cost when seeking medical care, with complete disregard for physician experience, expertise or other factors related to quality of care, amongst other harmful provisions.
  • Drug Pricing: ISMS stopped legislation by insurers that would have coerced patients to choose the lowest-cost healthcare option by offering financial incentives.

To see ISMS’ specific work on more insurance related issues, please view the end of session legislative reports.

Currently Tracked Bills

ISMS Supports

Insurance coverage for victims of domestic violence: HB 4337 (Sponsor: Rep. Kelly M. Cassidy) - House Bill 4337 requires health insurance plans to provide insurance coverage for aesthetic services and restorative care provided for the treatment of physical injuries to victims of domestic violence.  It is understood that cosmetic treatments may significantly improve patient outcomes, and these aesthetic services along with restorative care should be considered medically necessary and covered by insurance. This bill was assigned to the House Insurance Committee.

Related Resources

Understanding the Patient’s Out-of-Pocket Expenses
Understanding the Patient’s Out-of-Pocket Expenses
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