Illinois Compiled Statutes 215 ILCS 200/40 – Requirements for adverse determination
Current as of: 2024 | Check for updates
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If a health insurance issuer or its contracted utilization review organization makes an adverse determination, the health insurance issuer or its contracted utilization review organization shall include the following in the notification to the enrollee, the enrollee’s health care professional, and the enrollee’s health care provider:
(1) the reasons for the adverse determination and
(1) the reasons for the adverse determination and
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related evidence-based criteria, including a description of any missing or insufficient documentation;
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(2) the right to appeal the adverse determination;
(3) instructions on how to file the appeal; and
(4) additional documentation necessary to support the
Terms Used In Illinois Compiled Statutes 215 ILCS 200/40
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
(3) instructions on how to file the appeal; and
(4) additional documentation necessary to support the
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appeal.
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