Illinois General Assembly - Illinois Compiled Statutes

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215 ILCS 134/35

(215 ILCS 134/35)

Sec. 35.

Medically appropriate health care protection.

(a) No health care plan or its subcontractors shall retaliate against a
physician or other
health
care provider who advocates for appropriate health care services for
patients.

(b) It is the public policy of the State of Illinois that a physician or any
other health care provider be encouraged to advocate for medically appropriate
health care services for his or her patients.  For purposes of this Section,
"to advocate for medically appropriate health care services" means to appeal a
decision to deny payment for a health care service pursuant to the
reasonable grievance or appeal procedure established by a health care plan
or to protest a decision, policy, or practice that the
physician or other health care provider, consistent with that degree of
learning and skill ordinarily possessed by physicians or other health care
providers practicing in the same or a similar locality and under similar
circumstances, reasonably believes impairs the physician's or other health care
provider's ability to provide appropriate health care services to his or her
patients.

(c) This Section shall not be construed to prohibit a health care plan or
its subcontractors from making a
determination not to pay for a particular health care service or to prohibit a
medical group, independent practice association, preferred provider
organization, foundation, hospital medical staff, hospital governing body or
health care plan from enforcing reasonable peer review or utilization
review
protocols or
determining whether a physician or other health care provider has complied with
those protocols.

(d) Nothing in this Section shall be construed to prohibit the governing
body of a hospital or the hospital medical staff from taking disciplinary
actions against a physician as authorized by law.

(e) Nothing in this Section shall be construed to prohibit the Department of
Professional Regulation from taking disciplinary actions against a physician or
other health care provider under the appropriate licensing Act.

(f) Any violation of this Section shall be subject to the penalties under
this Act.

(Source: P.A. 91-617, eff. 1-1-00.)