New laws will curb surprise medical billing, align premiums with coverage

[May 31, 2022] By Kevin Bessler | The Center Square

(The Center square) – Illinois patients who receive surprise medical bills now have somewhere to turn to under a new law that is now on the books.

The measure allows the Illinois Department of Insurance additional authority to assist consumers who were billed at out-of-network rates after receiving care from hospitals.

The bill’s sponsor, state Rep. Bob Morgan, D-Deerfield, said in some cases a person isn’t able to find their network.

“When you have a healthcare emergency, you don’t have the time or frankly even the opportunity and resources to try to figure out who the doctors and the healthcare professionals are in-network versus out-of-network,” Morgan said.

Prior to the federal No Surprises Act going into effect in January 2022, consumers who received care from out-of-network providers could be responsible for the difference between the charges the provider billed and the amount paid by their health plan, even when receiving care at an in-network facility.

“This new law will provide even more protection for consumers from exorbitant out-of-pocket healthcare costs, especially at a time when many families are struggling to pay other household bills,” state Sen. Ann Gillespie, D-Arlington Heights, said.

Another law creates the Health Insurance Coverage Premium Misalignment Study Act. It directs the Department of Insurance to oversee a study to explore rate setting approaches to investigate a misalignment of premiums in Illinois' individual health insurance market.

“The Shriver Center supports the Department of Insurance in their commitment to study whether premiums are misaligned across different tiers of coverage in the state’s health insurance marketplace,” said Stephani Becker, associate director of Healthcare Justice at the Shriver Center on Poverty Law. “The findings of this study will make health insurance more affordable for low- to middle-income Illinois residents and have a huge impact on over 300,000 Illinoisans who obtain coverage through the marketplace.”

Kevin Bessler reports on statewide issues in Illinois for the Center Square. He has over 30 years of experience in radio news reporting throughout the Midwest.