IL SB3278

Amends Illinois Insurance Code to prohibit insurers, dental service plan corporations, and insurance network leasing companies from denying claims for procedures specifically included in a prior authorization, effective on or after the bill's effective date.

Defines "prior authorization" as predetermination or authorization issued in verifiable form (letter, facsimile, email) indicating specific procedures are covered under a patient's dental plan at a specific reimbursable amount, subject to applicable coinsurance and deductibles.

Establishes five circumstances under which claims for prior-authorized procedures may be denied: (1) benefit limitations reached after prior authorization, (2) claim documentation fails to support original authorization, (3) patient condition changed making procedure no longer medically necessary, (4) patient condition changed requiring disapproval under current plan terms, or (5) another payor is responsible for payment.

Prohibits dental service contractors from recouping claims solely due to loss of coverage or patient ineligibility if the contractor erroneously confirmed coverage and eligibility despite having sufficient information indicating the patient was no longer covered or eligible.

Prohibits waiver of these provisions by contract.