Illinois Out-Of-Network Demand For Arbitration

ILLINOIS NONPARTICIPATING FACILITY-BASED PHYSICIANS AND PROVIDERS / INSURER OR HEALTH PLAN Demand for Arbitration Pursuant to Illinois Insurance Code, Section 356z.3a. This form is used to initiate the arbitration process for disputes between nonparticipating facility-based physicians and providers and insurers or health plans in Illinois. Under Illinois law, nonparticipating facility-based physicians and providers are healthcare professionals who provide services at a facility that is in-network with an insurer or health plan, but who are not themselves contracted with the insurer or health plan. Section 356z.3a of the Illinois Insurance Code provides a mechanism for resolving disputes between these providers and insurers or health plans through binding arbitration. The Demand for Arbitration form is used to initiate this arbitration process. It typically includes information such as the names and addresses of the parties involved, a description of the dispute, and the relief sought. The form may also require the parties to attach relevant documents, such as contracts or invoices related to the dispute. www.FormsWorkflow.com