Not All Illinois Health Insurance Policies Provide Consumer Protection Health Carrier External Review Act PDF Print E-mail
Written by Mike Novelli   
Tuesday, 31 August 2010 18:38
On July 1st, the Health Carrier External Review Act became effective, authorizing Illinois health insurance policyholders the autonomy to obtain an independent review for the rejection of health insurance claims. But buyers should be cautious, as the law does not encompass all Illinois health insurance agencies.
by MikeNovelli


On July 1st, the Health Carrier External Review Act became effective, authorizing Illinois health insurance policyholders the autonomy to obtain an independent review for the rejection of health insurance claims. But buyers should be cautious, as the law does not encompass all Illinois health insurance agencies.

Debatable in nature, the modifications, legislated by the federal government, authorize carriers to appeal denied pre-authorized claims and services that do not meet various Illinois health insurance providers' terms of "medically deemed necessary" services.

Previously, numerous Illinois health insurance subscribers were not only encumbered with exorbitant monthly premiums, but often impelled to remit the financial responsibility of many out pocket claims that should be covered.

Previous to President Barack Obama's signage of the momentous bill, Illinois health insurance agencies were liberal with claim rejections. Amid the beneficial characteristics of these new laws, consumers should beware of how the ramifications affect the Illinois health insurance decision.

For example, group major medical health insurance policies and Health Maintenance Organizations are legally responsible to provide an external independent review, following to the terms demarcated in the Health Carrier External Review Act. Conversely, individual and various small groups do not garner any legal requirements, indicating that policyholders are void of any legal recourse for pre-authorized medical services and a slew of other medical claims.

As a result, Michael Novelli, the president and licensed agent of Illinois Life and Health prognosticates that a new strain of illicit policies will hatch, hyping external review benefits for an additional cost. Consequently, consumers should be apprehensive of any Illinois health insurance policy, entailing the consumer to pay higher premiums to qualify for external review benefits.

Even though the Health Carrier External Review Act mandates that the Illinois health insurance company is responsible for the entire expenditures of an external review, the law does not have any impact over small business sponsored plans or program devised for specific conditions. Those, which are not covered under the are not Health Carrier External Review Act, include: Long-term care insurance, self-insured employer, cancer only policies, as well as limited supplemental benefits.

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.

DISCLAIMER: This article is provided as information only and is not to be taken as financial advice.

See how Illinois Health Insurance differs to the colleges sponsored health plan. Obtain quotes for Illinois Medical Insurance at IllinoisLifeandHealth.com.