Illinois Hmo Laws Champion Patient Rights - Brief Article

Healthcare Financial Management, August, 2000

State-regulated HMOs operating in Illinois must meet regulations designed to ensure that patients receive appropriate care within a reasonable time period. A law that took effect July 1 gives Illinois HMO members who change health plans or whose physician leaves the HMO network 90 days to find a new physician.

In addition, the state's HMOs are required to meet utilization review standards of the American Accreditation Healthcare Commission. A patients' bill of rights law that took effect January 1 in Illinois gives more than 2 million HMO members in the state greater access to specialists and procedures by which to appeal insurance decisions. Neither law covers members of PPOs, traditional fee-for-service plans, or self-insured managed care plans, which insure most of the state's residents.