Don’t Hesitate – File a Complaint with the Illinois Department of Insurance!

November 17, 2023

If you believe a health insurance company is violating the Network Adequacy and Transparency Act (NAT Act), the Prior Authorization Reform Act or any other insurance law or regulation, please file a complaint by accessing the IDOI Help Center. When appropriate, encourage your patients to also file complaints. Doing so is what drives the Illinois Department of Insurance (IDOI) to take action! If you need help, contact the DOI’s Office of Consumer Health Insurance by calling 877-527-9431.

The NAT Act, initiated by ISMS, took effect Jan. 1, 2019, and mandates health insurance carriers to maintain an adequate network of providers. Insurers must provide an up-to-date, accurate provider directory and follow the proper time/distance standards as required by this law. An adequate network of physicians is essential for patient access to care!

If you or your practice routinely hear from new patients that you are listed in a provider directory as “in-network” when in fact you don’t take that insurance, please file a complaint!

The rules also support continuity of care for patients during any network transition.

The Prior Authorization Reform Act, also initiated by ISMS, is designed to significantly reduce delays for patient care and applies to state-regulated insurance plans. The law established minimum qualifications for individuals who can deny a prior authorization request and specifies the information that a utilization review entity must provide at the time of denial, which helps the physician understand what additional information may be needed to support an approval for the service.

Insurance companies must be held accountable to provide what they have promised to their insureds. Taking action to file a complaint is an important step against wrongful health insurance company practices!

Learn more by visiting IDOI’s web page on Understanding the Consumer Complaint Process.

If you have questions, please contact ISMS Senior Vice President of State Legislative Affairs Erin O'Brien by email.

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