Bill > S589

This bill proposes to limit insurers' ability to retroactively deny claims for mental health and substance use disorder services. The key provisions are: 1. Insurers cannot impose a retroactive claim denial on a provider (mental health or substance use disorder clinics, professionals, etc.) unless it has been less than 12 months since the claim was submitted, the insurer provides a written explanation for the denial, and the provider is given 30 days to submit additional documentation or take corrective action. 2. Retroactive denials are allowed after 12 months only in cases of fraud, legal action, if the provider or insured has already been paid, or if the services were not provided. 3. If a retroactive denial is due to expected payment from another payer, the insurer must notify the provider at least 15 days in advance and the provider has 12 months to determine if the claim is subject to payment by a secondary insurer. 4. The bill defines key terms like "provider," "retroactive claim denial," and "behavioral health services" to clarify the scope of the legislation. The overall goal of the bill is to protect mental health and substance use disorder providers from unfair retroactive denials of previously paid claims by insurers.

Budget and Finance, Business and Industry, Health and Social Services

https://malegislature.gov/Bills/191/S589