Rep. Tom Demmer (R-Dixon) wanted to know how the Illinois Department of Insurance (IDOI) is handling mental health and addiction parity insurance coverage grievances.
At a House Mental Health Committee hearing Friday on addiction parity, which dealt greatly with mentally ill and addicted patients not receiving timely care due to insurance coverage that has proven to result in death, the Demmer directed all of his questions to IDOI Director Jennifer Hammer.
“You mentioned there is an ability for individuals to complain to the department,” Demmer said. “Can you tell us a little bit about what that process looks like and how you hold an insurance company accountable through that complaint process?”
Rep. Tom Demmer
According to Hammer, the consumer complaint process is the third prong in the IDOI’s regulatory approach to deal with consumers complaints, which are most often given by the consumer or their power of attorney.
“The department would look at the factual scenario and send it directly to the insurance company for their response and the policy language associated with that complaint,” Hammer said, adding IDOI would then address both sides of the alleged discrepancy. “We mediate the situation so that consumers in the state are absolutely getting the coverage that they paid for, deserve, but also need.”
Demmer wanted to know the “potential outcomes” of such mediation.
“Our intent is to always make the consumer whole and make a determination as to whether the policy covered those services and then collect the data associated with those complaints,” Hammer said.
Hammer said if there are any apparent trends in specific counties, insurance carriers, consumers or specific treatments, the IDOI utilizes the data and analysis to trigger market conduct combinations and audit insurance companies.
“The Department of Insurance has the authority to fine insurance companies,” Hammer said. “Not only do we make sure that the consumer is whole, but that the insurance company knows that they have to comply with all of the state statutes.”
“If the department notices that there are a number of complaints about the same plan, the same insurer and the same service, could that trigger a larger review, which could result in fines?” Demmer asked.
“That’s exactly right,” Hammer said, adding from a “mental health parity market conduct review,” the IDOI assures consumers are satisfied from the beginning to the end of their treatment.
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