HB3650 Summary

• Establishes new Section 356f.1 of the Illinois Insurance Code requiring health insurance policies and managed care plans to implement standardized appeals procedures for coverage denials and service disputes.

• Creates expedited 24-hour appeal review process for urgent health care matters where denial could significantly increase risk to enrollee's health, with decisions communicated orally and in writing.

• Implements standard 15-business-day appeal review process for non-urgent health care services, with written notification to enrollee, physicians, and health care providers.

• Requires appeals to be reviewed by clinical peers without involvement in the initial determination, with written decisions including clear reasons, medical criteria based on sound clinical evidence, and procedures for external independent review.

• Establishes external independent review process where an independent clinical reviewer can overturn plan denials if service is deemed medically appropriate, with plan responsible for reviewer fees and protection from liability for good faith reviewers.