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Illinois doctors to advise state officials on insurance complaints

Under a volunteer arrangement, the Illinois Academy of Family Physicians will counsel regulators faced with evaluating health plans' coverage decisions and rescissions.

By Emily Berry — Posted July 23, 2010

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Illinois family physicians will be on call for a new reason starting this summer: to answer questions from state officials investigating consumer complaints about health insurance.

Under an arrangement announced in June, leadership of the Illinois Academy of Family Physicians will offer on-call expertise for state regulators faced with evaluating medical coverage decisions that determine whether a consumer has a legitimate complaint.

A new state law giving Illinois residents the right to an independent review of health insurance claims denials took effect July 1.

Illinois Gov. Pat Quinn and State Insurance Director Michael McRaith have asked legislators to pass further reforms, including limits on insurance rescissions, because Illinois has the highest rescission rate in the country -- almost 50% more than California, where rescissions have been a prominent public issue, according to the insurance department.

The family physicians who will review denials and rescissions are mostly current or retired board members for the academy. They won't be paid and won't see any confidential information related to the cases, said academy spokeswoman Ginnie Flynn. At this article's deadline, no reviews had been initiated.

Quinn praised the partnership in a statement June 22, calling it a "groundbreaking public-private partnership."

McRaith said the partnership is meant to help officials without medical expertise investigate complaints more thoroughly.

"As we move forward with implementing health reform and as we look back upon the landscape of problems we have in our health insurance market, the one need became more apparent than others -- that is our need as regulators to have direct access to health care providers," he said. But "as a state agency, we don't have resources or wherewithal to hire a medical doctor to serve on our staff."

He said the doctors won't be making any specific recommendations, but rather offering expert knowledge that might help the insurance department employee evaluate a case.

McRaith said he didn't know of any other states that had similar agreements in place with physicians, but knew some of his counterparts in other states are "intrigued by our idea."

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