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It’s a common practice among health insurance companies: denying coverage for a procedure or test a doctor recommends, and denying transfers and inpatient admissions. Denials through prior authorization can delay care that worsen patient health and lead to poor outcomes.

Gov. JB Pritzker, in his Budget Address, promised to introduce a bill to “curb predatory insurance practices—putting power back into the hands of patients and their doctors.” The Illinois hospital community backs that bill, HB 5395, which would end prior authorization for inpatient mental health care for children and adults for the first 72 hours.

We agree when the Governor said, “Doctors and their patients should be making decisions about patient care.… We should never, ever, ever, ever cede those decisions to the whims of insurance executives whose focus is always on the bottom line.”

The Illinois Health and Hospital Association—and our membership of 211 hospitals—strongly supports efforts to hold insurance companies accountable and keep medical decisions in the hands of patients and medical professionals.

Additional prior authorization reforms must extend to Medicaid managed care organizations (MCOs). Inappropriate denials negatively impact healthcare for Medicaid patients, while reducing MCOs’ costs and increasing shareholder profits. Support IHA’s MCO prior authorization reforms.