SB2295 Summary

• Amends the Illinois Insurance Code to allow binding arbitration on a per-bill or batched-bill basis (instead of only per-bill) when payment disputes between health insurance issuers and nonparticipating providers cannot be resolved within 30 days after receipt of written explanation of benefits.

• Requires health insurance issuers to ensure patients incur no greater out-of-pocket costs when receiving emergency services from nonparticipating providers or facilities compared to in-network providers, with cost-sharing calculated based on the recognized amount.

• Extends protections to non-emergency ancillary services (anesthesia, radiology, pathology, etc.) provided by nonparticipating providers at participating health care facilities, requiring the same cost-sharing as in-network providers.

• Establishes an arbitration process using American Arbitration Association or American Health Lawyers Association trained arbitrators selected from a Department of Insurance-approved list, with written decisions required within 45 days.

• Prohibits referral requirements or policy provisions from denying coverage or reducing benefits for services covered under the bill's protected situations.