State playbook

Illinois

State insurers, legislation, and appeal resources for patients and advocates in Illinois.

4 guides

Beginner guide for Illinois—Get Covered Illinois, IDOI external review, PA reform deadlines, and what to open next.

215 ILCS 200—5-day and 48-hour PA decisions, deemed authorization, 6/12-month approvals, and Rx PA rules.

215 ILCS 134/45—24-hour urgent and 15-business-day standard appeals, clinical peer review, path to IDOI.

Binding IRO review—4-month filing, no consumer fee, 45-day standard, 72-hour expedited, 215 ILCS 180.

Prior auth & internal appeals

Match the plan on the member ID card. Use the denial letter for where to file appeals.

After internal appeal, for eligible Illinois fully insured plans only.

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