Prior Authorization

The Illinois State Medical Society (ISMS) is concerned that prior authorization is overused by health insurers and places unnecessary burdens on patients and physicians. Prior Authorization (PA) requires physicians to submit additional forms and documentation before the care they recommend for their patients will be approved for payment by the insurer.

In early 2019, ISMS surveyed more than 1,000 Illinois physicians to assess concerns about PA and its overall impact on patient care. Over 90% of physicians say the process has gotten worse and 95% said prior authorization has had a negative effect on patients.

In 2021, House Bill 711 passed unanimously through both houses of the Illinois General Assembly. This bill will bring much-needed speed and transparency to prior authorization processes, ensure that qualified professionals are making prior authorization determinations, and protect continuity of care for patients. The Your Care Can’t Wait Coalition thanks every Illinois lawmaker for taking this historic step to protect patients, and thanks every patient and healthcare professional who lent your voice to this important effort!

Currently Tracked Bills

ISMS re-introduced the Prior Authorization Reform Act, House Bill 711 (Sponsor: Rep. Greg Harris/Senator Linda Holmes) designed to reform the prior authorization process by:

  • Increasing transparency. The bill will require payers to maintain and publicly post a list of services for which prior authorization is required;
  • Establishing important maximum timelines for urgent and non-urgent prior authorization requests. Currently there are no standard timelines, forcing patients to wait an excessive amount of time, often weeks, before care can be initiated;
  • Providing for continuity of care for patients by requiring that prior authorization approvals remain in effect for certain lengths of time, especially important for patients in chronic care;
  • Defining qualifications of individuals designated to review and make prior authorization determinations.

HB 711 passed both chambers unanimously and will be sent to the Governor for final action.

Related Resources

ISMS Coalition Position Paper
ISMS Coalition Position Paper
Support HB711 to ensure that patients get the necessary care they need
Read the Position Paper
Your Care Can't Wait!
Your Care Can't Wait!
It’s time to fix prior authorization in Illinois
Go to Website
The Problem with Prior Authorization
The Problem with Prior Authorization
Read Survey

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