Need a Refresher on Illinois’ Surprise Billing Law?
June 21, 2024
What doctors need to know!
A law enacted in 2022 expanded the scope of Illinois’ surprise billing law to more closely align with the federal No Surprises Act (NSA).
Most significantly, the Illinois law:
- Extends the prohibition against balance billing to all non-participating facility-based physicians delivering services at an in-network hospital or other facility.
- Adopts the federal NSA definition of “qualifying payment amount,” specifically for reference in determining patient cost-sharing amounts for out-of-network services within the scope of the law.
- Prohibits the Qualifying Payment Amount (QPA) from being used as the primary consideration by arbitrators in payment disputes about out-of-network costs.
As state law continues to “remain silent” on the issue of good faith estimates, all physicians and providers in Illinois must make good faith estimates (GFEs) available consistent with provisions in the federal NSA. In addition, the Illinois law does not substantially change the arbitration process that currently exist for surprise billing disputes.
The NSA does not supersede current state law but is intended to work in a complementary fashion to ensure broad protections under all insurance plans.
ISMS’ Issue Brief, Surprise Billing: An Overview of the Federal No Surprises Act and Its Interaction with Illinois’ Law, covers Illinois’ surprise billing law, along with state and federal overlap. The resource also offers guidance about what physicians need to address to comply with the federal No Surprises Act. Many of the provisions of the NSA also took effect Jan. 1, 2022.
Questions? Please contact the ISMS Health Policy Research and Advocacy team by email.