Is a Health Insurance Company Violating a Law or Regulation? Time to Tell the DOI

January 27, 2023

ISMS’ comprehensive resource covers how to file a complaint

If health insurance companies are not complying with laws, the Illinois Department of Insurance (DOI) needs to know!

The DOI is charged with holding insurance companies accountable to state insurance laws and regulations.

In recent years, ISMS has worked with legislators in Springfield to pass two significant and comprehensive laws that require insurance companies to be more accountable to patients and physicians:

  • The Network Adequacy and Transparency Act helps to ensure patients have convenient access to physicians and healthcare facilities that are in network with their insurance plan.

  • The Prior Authorization Reform Act increases transparency of prior authorization processes and requires insurers to provide timely determinations based on evidence-based criteria.

If you think a health insurance company is violating these laws or any other law or regulation, please file a complaint with the DOI. As you know, these types of issues can limit access to timely and necessary patient care. When appropriate, encourage your patients to file complaints by using the same portal. Need help? Contact the DOI’s Office of Consumer Health Insurance toll free at 877-527-9431.

To learn more, access ISMS’ resource, Health Insurance Complaints? The Department of Insurance Needs to Know
Questions? Please contact the ISMS Health Policy Research and Advocacy team by email.

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