SB2379 Summary

• Prohibits insurers offering group or individual accident and health insurance policies or qualified health plans from using extrapolation or statistical sampling methodology to recoup payments from health care providers, effective upon enactment of the amendatory act.

• Requires all recoupment or offset requests to be submitted in writing with complete Current Procedural Terminology (CPT) codes and patient encounter data including dates of service and patient names.

• Provides health care professionals and providers a minimum of 120 days to respond to recoupment requests after receiving required information, with no recoupment permitted unless all requirements are met.

• Classifies use of extrapolation or statistical sampling for recoupment as an unfair and deceptive act under the Illinois Insurance Code, enforceable through court action or mandatory arbitration with right to recover attorney's fees.

• Makes conforming amendments to multiple acts including the State Employees Group Insurance Act, Counties Code, Municipal Code, School Code, HMO Act, Limited Health Service Organization Act, Voluntary Health Services Plans Act, and Illinois Public Aid Code.