DECATUR, Ill. – State Rep. Sue Scherer, D-Decatur, is cracking down on bad actors in the insurance industry by calling for legislation giving the Department of Insurance (DOI) more tools to regulate, analyze and investigate claims of malfeasance such as ghost networks.
“Major health insurance companies have gotten away with doing much too little for too much money for far too long,” said Scherer. “In communities throughout the state, big insurance companies often do not sell their products as advertised, with little to no recourse available to affected consumers. I shouldn’t have to show up to a health care center only to find out that my needs won’t be met despite what they first indicated to me.”
Scherer recently introduced House Bill 4126, which will allow the Department of Insurance to analyze trends in the insurance industry, investigate claims of wrongdoing and establish penalties for dishonest behavior. For instance, the department will be able to conduct investigations and hearings in response to inquiries from policyholders and others. Insurance companies must keep up-to-date records of in-network providers and adhere to standards of continuity of care, meaning that patients must be able to access care without being imposed with burdensome travel.
Big health insurance companies often skate by these requirements by listing providers, who have either moved to another facility or are not accepting new patients, as in-network which leads to patient frustration and inaccessibility of health care. These no-show providers are part of what the bill’s advocates refer to as ‘ghost networks’, and many large insurance companies have relied on them to skirt requirements. The Department will develop the standards, which carry monetary penalties if ignored, in accordance with the standards set forth in the industry’s own National Association of Insurance Commissioners.
Scherer was inspired to take on the health insurance industry after negotiations between Springfield Clinic and Blue Cross Blue Shield of Illinois (BCBSIL) broke down last year, which left according to the clinic, 100,000 Illinoisans without access to critical health care. To meet continuity of care requirements, BCBSIL often referred patients to providers that were much further away from patients and often worse in quality in comparison to the highly-specialized care available at Springfield Clinic. Additionally, those granted extensions for the most serious conditions often complained about bureaucratic hurdles, insufficient extension time and transparency. Scherer hopes that granting the Department of Insurance more authority to investigate these behaviors will end these harmful practices and `bring more Doctors to patients across Illinois.
The legislation continues Scherer’s efforts to hold the insurance industry accountable. She led a bipartisan group of legislators and introduced a similar bill in 2022. The bill was also supported by Gov. J.B. Pritzker and the Department of Insurance.
“Equipping the state with the tools it needs to curtail this dishonest behavior will benefit all Illinoisans. Too many people suffer from chronic and acute illnesses while they languish due to a lack of adequate care available to them,” said Scherer. “If I purchase an insurance policy with certain terms and conditions, it should be made plain what that entails without any misinformation or deception. As Big Health Insurance companies rake in record profits, people are dying from a lack of access to care. And I won’t stand for it.”