On July 1st, the Health Carrier External Review Act went into effect, authorizing consumers of Illinois health insurance the autonomy to request an independent review on the denial of health insurance claims. But buyers should beware that the law does not impact all Illinois health insurance companies.
Controversial in nature, the amendments to medical coverage, mandated by the federal government grants carriers the right to counter denied pre-authorized claims and services, excluding Illinois health insurance providers’ definitions of situations deemed medically unnecessary.
In the past, many Illinois health insurance subscribers were not only saddled with hefty monthly premiums, but often rejected and left the financial responsibility of many out pocket claims.
Prior to President Barack Obama’s signage of the revolutionary bill, Illinois health insurance agencies were liberal with claim rejections. But while these new laws may seem beneficial, consumers should be cognizant of how these laws influence the Illinois health insurance buying decision.
For instance, Health Maintenance Organizations and group major medical health insurance policies are legally bound to offer an external independent review, which adheres to the terms demarcated in the Health Carrier External Review Act. However, individual and certain small groups do not hold any legal requirements, meaning that policyholders do not have any legal recourse for pre-authorized medical services and other medical claims.
As a result, Michael Novelli, the president and licensed agent of Illinois Life and Health predicts that a fresh crop of illicit policies will harvest, touting external review benefits for an additional cost. Consequently, consumers should be leery of any Illinois health insurance policy, requiring the consumer to pay higher premiums to attain external review benefits.
Even though the Health Carrier External Review Act requires that the Illinois health insurance company covers the entire cost of an external review, the law does not have any influence over small insurance providers or plans designed for specific conditions. Cancer only policies, long-term care insurance, self-insured employer plans as well as limited supplemental benefits are not covered under the Health Carrier External Review Act.
To balance policies excluded under the Health Carrier External Review Act supplement specific medical policies with a major Illinois health insurance plan. Mr. Novelli also advises comparing a minimum of three health quotes, perusing each benefit prior to the selection of a new Illinois health insurance plan.
See how Illinois Health Insurance differs to the colleges sponsored health plan. Obtain quotes for Illinois Medical Insurance at IllinoisLifeandHealth.com.
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