Illinois General Assembly - Illinois Compiled Statutes

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215 ILCS 125/4-10

(215 ILCS 125/4-10) (from Ch. 111 1/2, par. 1409.3)

Sec. 4-10. Medical necessity; dispute resolution; independent second opinion.

Each Health Maintenance Organization shall provide a mechanism
for the timely review by a physician holding the same class of license as
the primary care physician, who is unaffiliated with the Health Maintenance
Organization, jointly selected by the patient (or the patient's next of
kin or legal representative if the patient is unable to act for himself),
primary care physician and the Health Maintenance Organization in the event
of a dispute between the primary care physician and the Health Maintenance
Organization regarding the medical necessity of a covered service proposed
by a primary care physician.  In the event that the reviewing physician
determines the covered service to be medically necessary, the Health
Maintenance Organization shall provide the covered service.  Future
contractual or employment action by the Health Maintenance Organization
regarding the primary care physician shall not be based solely on the
physician's
participation in this procedure.

(Source: P.A. 100-201, eff. 8-18-17.)