Governor Ryan Announces Toll Free Number For Consumer Health Insurance Assistance

SPRINGFIELD -- Governor George H. Ryan today announced the formation of the Illinois Office of Consumer Health Insurance. The office was formed as part of the Managed Care Reform and Patient Rights Act the Governor signed into law last August.

Illinois consumers who have questions or problems with their health maintenance organizations or other health insurance can call the Office of Consumer Health Insurance toll free at (877) 527-9431.

"The Office of Consumer Health Insurance is an important new resource for Illinois citizens," Ryan said. "Citizens now have a number to call to get help in checking and understanding their health care coverage."

The most significant new patient rights mandated by the managed care law are:

• The right to receive detailed coverage information from an HMO, including information on: the areas of the state served by the plan; exclusions and limitations; pre-certification and utilization review requirements; emergency room coverage and requirements; selection of primary care physicians; access to specialty care; benefits available for out-of-area coverage; out-of-pocket expenses; provisions for continuity of care; and an explanation of the appeals process.

• The right to receive coverage for emergency services when a "prudent person" would reasonably believe the condition is serious enough to require emergency medical attention.

• The right to apply for a standing referral from a primary care physician when a medical condition requires ongoing care from a specialist and, in some cases, to have the HMO provide access to such specialty care outside the network; and

• The right to appeal decisions made by an HMO.

"The Department of Insurance has always provided consumer assistance and education, but this toll free number will make the services more convenient and accessible to Illinoisans throughout the state," Ryan said.

Ryan said the Office of Consumer Health Insurance will also be instrumental in assessing and making recommendations on health care laws and regulations, conducting research on health care issues, and collecting and reporting statistical information on consumer inquiries and complaints.