Overview
Illinois SB 1840 (effective 2021) prohibits balance billing for emergency services and unplanned out-of-network care at in-network facilities. Providers may not bill patients the difference between their charges and insurer payments for covered services. Balance billing disputes are resolved through IL DOI arbitration.
Key Requirements
- Patients at in-network facilities who receive emergency care from OON providers are protected from balance bills.
- Unplanned OON services at in-network facilities are covered under in-network rates; providers may not charge more.
- Patients must receive notice of balance billing rights before or at time of service.
- Providers must submit disputes to IL DOI arbitration within 60 days of claim denial or payment.
- Insurers must respond to arbitration requests within 30 days with full documentation and fee justification.
Penalties and Enforcement
Providers who balance bill in violation of SB 1840 face penalties from IL DOI and license discipline. Patients may file complaints directly with the Department of Insurance. Insurers who fail to honor arbitration awards face fines and license sanctions. The IL DOI enforces compliance through complaint investigation and enforcement actions.
Appeals and Exceptions
Balance billing protections do not apply to elective out-of-network services chosen by the patient. Emergencies and unplanned care at in-network facilities are protected regardless of provider in-network status. Federal NSA standards may provide additional protections in some cases. Arbitration decisions may be appealed under limited circumstances.
Interaction with Federal Law
Illinois balance billing law is stricter than the federal No Surprises Act in some respects. Both emergency and non-emergency OON services at in-network facilities are covered under SB 1840. The federal NSA covers emergencies; Illinois extends to planned OON services at in-network facilities. Providers must follow the more protective standard.
Common Questions
Am I protected from balance billing if I go out-of-network by choice?
No. Illinois protections apply to emergencies and unplanned OON services at in-network facilities. Elective out-of-network care selected by the patient is not protected.
What is the arbitration timeline in Illinois?
IL DOI arbitration typically resolves within 60-90 days of filing. Both parties must submit documentation within 30 days of filing, and the arbitrator issues a decision within 30 days thereafter.
Track Illinois Billing Rules Automatically
Altair tracks balance billing disputes by state and payer. See how it works.
State laws change. This reference is current as of 2026-04-06. Consult state statutes or a healthcare attorney for definitive guidance.