Illinois Surprise Billing Law

Overview

The Illinois Surprise Billing Protection Act (SB 1840, effective 1/1/2022) shields patients from balance bills when they receive emergency care or unplanned out-of-network services at in-network facilities. Providers cannot bill patients the difference between their charges and the in-network rate. Surprise billing disputes are resolved through IL DOI arbitration.

Key Requirements

1. Patients receiving emergency services at any facility are protected from surprise bills, regardless of provider in-network status.
2. Patients receiving unplanned OON services at in-network facilities are covered at in-network rates.
3. Facilities must disclose balance billing rights in writing within 30 days of the bill.
4. Providers must include EOB information and their own fee schedule with the bill.
5. Patients may dispute bills directly with the insurer or request IL DOI arbitration.

Penalties and Enforcement

Providers who violate SB 1840 face administrative fines and license discipline from the Illinois Department of Insurance. Insurers who fail to arbitrate or comply with awards face penalties and license sanctions. IL DOI investigates complaints and compels payment or credits to patients when violations are confirmed. Repeat violators face escalating penalties.

Appeals and Exceptions

Surprise billing protections apply to emergencies and unplanned services. Elective out-of-network care or services scheduled in advance by the patient are not protected. Federal NSA rules provide overlapping protection for emergencies. Arbitration decisions may be appealed to state court in limited circumstances.

Interaction with Federal Law

Illinois surprise billing law complements the federal No Surprises Act. Both cover emergency services. Illinois extends protection to non-emergency OON services at in-network facilities, which NSA does not. Patients receive the benefit of the more protective standard. Balance billing and surprise billing often overlap in coverage.

Common Questions