Bill > S663

This bill seeks to prevent inappropriate denials by insurers for medically necessary services. It would require insurers to pay for health care services ordered by the treating health care provider if they are a covered benefit and follow the insurer's clinical review criteria. The bill also places limits on insurers' ability to recoup payments, including prohibiting recoupment more than 90 days after the original payment was received if the provider can document that they verified the patient's eligibility at the time of service. Additionally, the bill requires insurers to conduct a retrospective review and reverse a denial if they determine the service was medically necessary, and to provide the provider with a clinical justification for any denial. The commissioner of insurance is directed to promulgate regulations to enforce these provisions.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/193/S663