Bill > S491

This bill aims to simplify administrative processes within the financial services sector, specifically concerning health insurance. It amends existing law by changing the timelines for how quickly insurance carriers or utilization review organizations (companies that review the appropriateness of medical care) must make decisions about the medical necessity of proposed treatments or services. Under the proposed changes, these decisions must be made within two working days of receiving all necessary information, which includes any required in-person evaluations or second opinions. If a service is approved, the provider must be notified within 24 hours, and if it's denied, the provider also gets a 24-hour notification, followed by written or electronic confirmation to both the provider and the patient within one working day. For ongoing care, like extended hospital stays, concurrent review decisions must be made within one working day of receiving all necessary information, with similar notification timelines for approvals and denials. Importantly, if a concurrent review results in a denial, the service must continue without cost to the patient until they are officially notified of the decision. The bill also removes a specific clause from another section of the law related to these processes.