Bill > HB2175

This bill introduces new requirements for health care insurers regarding the denial of claims and prior authorization requests. Specifically, before denying a claim or prior authorization request based on medical necessity, the insurer's medical director must conduct an individual review. During this review, the medical director is required to exercise independent medical judgment and cannot simply rely on recommendations from other sources. This means that the medical director must personally and critically evaluate each denial, ensuring a more thorough and personalized assessment of medical necessity. The bill applies to two different sections of Arizona Revised Statutes, covering both claim denials and prior authorization denials. The provisions will take effect on June 30, 2026, giving insurers time to adjust their review processes to comply with the new requirements. The goal appears to be protecting patients and healthcare providers by ensuring more rigorous and individualized decision-making when insurance claims or pre-authorization requests are being considered for denial.