Bill > H893

This bill aims to improve health insurance coverage for eating disorders by ensuring that insurance policies provide benefits for the diagnosis and treatment of mental disorders, including eating disorders, on par with coverage for physical conditions, meaning there should be no less restrictive annual or lifetime limits on services for mental health conditions than for physical health conditions. It also mandates that insurance carriers must offer a comprehensive range of inpatient, intermediate, and outpatient services for mental disorders, ensuring that medically necessary care is available in appropriate settings and that provider networks are sufficient to meet patient needs within a reasonable timeframe. The bill further clarifies and strengthens processes for utilization review, which is the system insurance companies use to evaluate the necessity and appropriateness of medical services, by requiring more detailed explanations for denied claims, ensuring that reviews consider individualized medical assessments, and making documentation available to patients and their doctors. Additionally, it enhances the external review process for denied claims, ensuring that appeals are handled by independent clinical experts and that the burden of proof lies with the insurance carrier to demonstrate that a denial was justified. Finally, the bill requires coverage for pediatric specialty care, including mental health, and mandates that medical necessity guidelines used by carriers be developed with input from practicing physicians, updated regularly, and based on evidence, with a focus on safety and efficacy over cost.