Springfield, IL (WAND) – Illinois will soon ban insurance companies from automatically coding a health service lower than what is provided to patients.
Gov. JB Pritzker signed a bill Friday stating all downcoding determinations must be made or reviewed by a real person, and insurance companies will be required to notify doctors if a service is downcoded.
The law also bans insurers from downcoding in a discriminatory manner against doctors who routinely treat patients with complex health conditions.
“Downcoding is patently unfair to medical professionals and the patient,” said Rep. Bill Hauter (R-Morton). “It ignores our training, experience, skill and education. All of this goes into medical decision-making. It ignores all that.”
Insurance companies will also be required to provide healthcare professionals a clear process to dispute downcoded claims within 90 days.
This law will take effect Jan. 1, 2028.
“Downcoding, quite frankly, is just an unfair system,” said Sen. Dave Koehler (D-Peoria). “There was some discussion about also trying to limit upcoding, but upcoding is primarily illegal.”
