Illinois Governor J.B. Pritzker recently approved legislation aimed at preventing insurance companies from engaging in what he referred to as “predatory tactics” that harm consumers by undercutting their medical necessities. The Healthcare Protection Act, a significant initiative from the last legislative session, was signed into law during a ceremony at Rush University System for Health in Chicago. Pritzker emphasized that the goal of the law is to give patients and their doctors more control over medical decisions.
The new laws, which will come into effect at various times, target practices like step therapy, which requires patients to use less expensive treatments before accessing a more costly option, even if recommended by their physician. Additionally, the legislation prohibits pre-authorization for mental health emergencies and the sale of inadequate insurance policies. These measures are intended to ensure that patients receive appropriate care without unnecessary delays or denials for profit-driven reasons.
Advocates of the legislation, including Bill Smith from mental health advocacy group Inseparable, applaud the changes, stating that individuals struggling to obtain proper medication for mental health conditions will benefit greatly. The laws were crafted in collaboration with medical professionals to address the obstacles they encounter when providing healthcare.
Furthermore, the legislation requires insurers to meet the standards set by the Affordable Care Act, eliminating gaps in coverage such as the exclusion of mental health treatments or pre-existing conditions. Insurers are now mandated to clearly outline prior authorization requirements in their communications and ensure an adequate number of in-network healthcare providers for timely access to care.
In a move to further protect consumers, the new laws extend existing regulations that prevent unfair rate hikes for individual policyholders to also include large group insurers. Last year, similar measures were implemented, and now, these safeguards will apply to a wider range of insurance plans to shield Illinois residents from unjust premium increases.