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Bill > H1148


MA H1148

To prevent inappropriate denials by insurers for medically necessary services


summary

Introduced
03/29/2021
In Committee
03/30/2022
Crossed Over
Passed
Dead
12/31/2022

Introduced Session

192nd General Court

Bill Summary

For legislation to prevent certain denials by insurers for medically necessary services. Financial Services.

AI Summary

This bill aims to prevent inappropriate denials by insurers for medically necessary services. It amends existing law to require carriers (i.e., insurance companies) to pay for healthcare services ordered by the treating provider if the services are covered benefits and follow the carrier's clinical review criteria. The bill also sets limits on carriers' ability to recoup or adjust payments, and requires carriers to conduct a retrospective review and reverse a denial if a service is found to be medically necessary, even if the provider had only a partial authorization. Finally, the bill directs the Commissioner of Insurance to promulgate regulations to enforce these provisions within 90 days of the bill's effective date.

Committee Categories

Business and Industry, Health and Social Services

Sponsors (1)

Last Action

Accompanied a study order, see H5222 (on 09/15/2022)

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