Bill > H945

This bill, concerning pre-authorization of medical and health care services, aims to regulate payments by health care carriers, which are insurance companies. It introduces a new section that defines "pre-authorization" as the prior approval from an insurance carrier for medical services deemed medically necessary and appropriate. The bill mandates that carriers must pay claims for services that received pre-authorization, unless specific exceptions apply, such as the patient not being covered at the time of service (with some exceptions for retroactive termination of coverage), the claim not being submitted on time, the patient exhausting their policy benefits after authorization but before service, the authorization being based on inaccurate information, the provider failing to perform the service, or the service being related to a pre-existing condition exclusion. The bill also clarifies that it does not prevent health plans from denying continued or extended coverage during concurrent reviews.