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Year in Review – Cook County Health & Hospitals System July 2015

Cook County Health & Hospitals System: A Year in Review
June 2014-June 2015


The Cook County Health & Hospitals System is in the midst of a transformative journey: continuing on with its historical mission of providing care to those most in need while adapting to an expanded role as a steward of population health and a Medicaid managed care health plan. It is with this lens that CCHHS is taking an innovative and integrated approach to the fulfillment of our mission by aligning our work as a provider of care, both in traditional and correctional settings, a public health authority and a health plan.


The system has achieved significant success in numerous arenas during the last 12 months thanks to the dedication and hard work of countless CCHHS clinicians, employees and partners and the aligned support of the CCHHS Board of Directors, Cook County Board President Toni Preckwinkle, Cook County commissioners, and legislators. This June CCHHS also recognized the one year anniversary of Dr. Jay Shannon’s tenure as CEO. This brief provides a summary of achievements CCHHS attained between June 2014 and June 2015.

 

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Global Market Opportunities for Medical Device & Equipment Manufactures

EXPORT GRANTS AND ROUNDTABLES FOR CHICAGO-AREA MEDICAL STARTUPS AND MANUFACTURERS


Metro Chicago medical supply manufacturers exported over $1.1 billion last year, fulfilling global demand for high quality American-made medical technology products. Metro Chicago exports more medical technology than any city except New York. Metro Chicago’s medical technology exports have grown by over 37% since 2007.


Is your company ready to join the global healthcare market?


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Consumers’ Rights for Independent External Review of Health Insurance Claims

Appealing Health Carrier Decisions

Helping your patients/clients appeal a denied service or treatment

 

The Illinois Department of Insurance is reminding consumers, health care providers, and patient advocates about consumers’ rights for an independent external review when their health insurance carrier denies a claim or request based upon medical necessity (including health care setting, level of care or effectiveness), experimental/investigational, a pre-existing condition, or rescission of the policy. 

This law applies to pre-service, concurrent stay and post service adverse determinations. If the situation is urgent (the time frame for a standard appeal or review could seriously jeopardize the life or health of the covered person), then an expedited internal appeal and/or expedited independent external review may be requested.  For all other requests, the internal appeals process through insurance carrier must be exhausted prior to requesting an external independent review. 

Requests for independent external reviews are filed with the Department of Insurance by fax, on-line or by U.S. mail.  An independent review organization (“IRO”) registered with the Department is randomly assigned to the review, which must be conducted by a clinical reviewer who is a physician or other appropriate health care provider with: (1) expertise in the treatment of the covered person’s medical condition that is the subject of the review, (2) knowledge about the recommended health care service or treatment through recent or current actual clinical experience treating patients with the same or similar condition of the patient, (3) holds a non-restricted license in the United States, and for physicians, a current certification by a recognized American medical specialty board in the area or areas appropriate to the subject of the external review; and (4) has no history of disciplinary actions. For standard reviews, the consumer and/or their authorized representative are notified by the Department of the IRO assigned to the review and are invited to submit any documentation applicable to the request.  The carrier is required to send all medical records related to the request to the assigned IRO.  Standard reviews are generally finalized within 4-6 weeks and the decision is final, but may be appealed through the court system.

Fully insured Illinois policies are subject to the Illinois law and it generally applies to most major medical polices, including those purchased under the Affordable Care Act (ACA).  However, the Department’s Office of Consumer Health Insurance assists consumers by trying to ascertain the type of plan involved, applicable appeal procedures and appropriate avenues for the appeal.

For more information regarding independent external reviews in Illinois, contact the Office of Consumer Health Insurance at (877) 850-4740 or visit the Department’s website at http://insurance.illinois.gov/ExternalReview/default.asp.  

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IMD&U: Learn Our Story. Share Our Vision.

As an IMD partner or key constituent, you aren’t just part of the Illinois Medical District story, you—and those you serve—are the heart of it. Throughout 2017 we will share monthly updates on all that is taking place in the IMD and encourage U to be part of our story by emailing IMD&U@medicaldistrict.org with ideas and topics of interest.

Join the conversation on Twitter and Facebook with the hashtag #IMDandU.


 

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