IL SB1506

Establishes the Health Carrier External Review Act to provide uniform standards for independent review of health carrier denials involving medical necessity, appropriateness, health care setting, level of care, or effectiveness.

Requires health carriers to notify covered persons in writing of their right to request external review when receiving adverse determinations or final adverse determinations, and allow both standard (within 4 months) and expedited (within 72 hours) review processes.

Creates approval and qualification standards for independent review organizations, including accreditation requirements, clinical reviewer qualifications, conflict of interest restrictions, and 24/7 toll-free telephone service.

Mandates that external review decisions are binding on health carriers and requires health carriers to pay all costs of external reviews and submit annual reports to the Director on external review requests and outcomes.

Applies to all health carriers in Illinois except those providing limited coverage (dental, vision, disability, Medicare supplements, workers' compensation, etc.) and managed care plans under the Managed Care Reform and Patient Rights Act.