Under Illinois Law, Insurers Must Keep Provider Directories Current, Ensure Adequate Networks
March 25, 2022
ISMS fought to help enact the Network Adequacy and Transparency Act (NAT Act), which took effect Jan. 1, 2019, and protects patients who purchase state-regulated private health plans. One of the key provisions of the NAT Act requires health plans to be transparent:
- Insurers are obligated to maintain updated provider directories. Physicians: Please check the directories to ensure that your information is correct. If it is not, please notify ISMS and the insurance company in question.
- If a doctor or hospital is dropped from a network, the insurance company must notify patients in a timely fashion.
- Doctors must notify patients if they leave a network.
Insurance companies must also ensure that plan networks have enough health facilities and doctors, including specialists, in close proximity to where their policyholders live.
If a patient's doctor is dropped from the network, pregnant women and patients with complex conditions will be able to stay with their doctors long enough to make a smooth transition – without getting charged extra.
If you have questions, please contact ISMS Senior Vice President of State Legislative Affairs Erin O'Brien by email.