Bill > H1148

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.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/192/H1148