The law in Illinois that could support patients by limiting the power of insurance companies

Have you ever had a health insurance company reject coverage for a procedure or medication? The Illinois House of Representatives has passed a bill that could reduce the power of insurance companies to determine whether a patient’s insurance plan will cover a treatment prescribed by a doctor. The legislation was passed on a bipartisan basis in the Illinois House of Representatives and now it moves to the Senate for debate. Leaders in the Senate have provided no timeline on when the bill will be brought to the floor, but its success in the lower chamber has many proponents of the law optimistic about its passage. empower

Targeting ‘utilization management’ and its cruel effects on patients

A press release describing the legislation published in mid-March says that one of the main ‘targets’ is “utilization management.’

So, what is utilization management, and how does it harm patients?

Utilization management covers a series of processes that force patients “to obtain permission from their providers before receiving care that doctors have already determined necessary,” reads the press release. Insurance companies use ‘prior authorization’ and ‘step therapy’ to erect barriers to care that boost profits off the backs of people who need help most. Lawmakers in the state were particularly worried about those with severe mental illness whose lives can be put at risk when these barriers to care are in place.

The new law would make Illinois a leader in mental health care by prohibiting “prior authorization for in-patient adult and children’s mental health care,” which had previously allowed insurance companies a say in whether a treatment prescribed by a doctor would be covered. Additionally, the bill includes a measure to ban step therapy, which is a part of utilization management where patients are mandated “to move through less effective treatment options before eventually gaining access to the treatment that doctors recommended initially.” During an event hosted by Gov. Pritzker earlier this week, he spoke directly to healthcare professionals who, in Illinois and across the country, have grown tired of insurance companies undermining their expertise and putting their patients at great risk.

For officials, patients, medical professionals, and healthcare activists, the new law will reduce the power of insurance companies to put profits over patient care and place the power to determine a course of treatment back with doctors. The message from the Governor could not be clearer: “The only people who should be making decisions about patient care are doctors and patients themselves — not an insurance employee with no medical background.”