(215 ILCS 134/55)
Record of complaints.
(a) The Department shall maintain records concerning the complaints filed
against health care plans. To that end, the Department shall require
plans to annually report complaints made to and resolutions by health care
plans in a manner determined by rule. The Department
shall make a summary of all data collected available upon request and publish
the summary on the World Wide Web.
(b) The Department shall maintain records on the number of complaints filed
against each health care plan.
(c) The Department shall maintain records classifying each complaint by
whether the complaint was filed by:
(1) a consumer or enrollee;
(2) a provider; or
(3) any other individual.
(d) The Department shall maintain records classifying each complaint
according to the nature of the complaint as it pertains to a specific function
of the health care plan. The complaints shall be classified under the
(1) denial of care or treatment;
(2) denial of a diagnostic procedure;
(3) denial of a referral request;
(4) sufficient choice and accessibility of health
(6) marketing and sales;
(7) claims and utilization review;
(8) member services;
(9) provider relations; and
(e) The Department shall maintain records classifying the disposition of
each complaint. The disposition of the complaint shall be classified in one of
the following categories:
(1) complaint referred to the health care plan and no
further action necessary by the Department;
(2) no corrective action deemed necessary by the
(3) corrective action taken by the Department.
(f) No Department publication or release of information shall identify any
enrollee, health care provider, or individual complainant.
(Source: P.A. 91-617, eff. 1-1-00.)