Bill > H1087

This bill aims to prevent inappropriate denials by insurers for medically necessary services. It amends the state's insurance laws to require insurers to pay for health care services if they are covered benefits and follow the insurer's clinical review criteria. The bill also places restrictions on insurers' ability to deny claims or recoup payments, such as prohibiting denials based on administrative or technical defects, and requiring insurers to conduct retrospective reviews and provide justification if they deny a claim due to a lack of authorization. The bill also directs the insurance commissioner to promulgate regulations to enforce these provisions.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/193/H1087