Bill > S596

This bill aims to enhance consumer rights regarding health insurance, particularly for behavioral health services, by strengthening oversight and transparency. It mandates that decisions on health insurance appeals must clearly inform individuals about their right to appeal to the Office of Patient Protection, including contact details and instructions on how to file a grievance. Furthermore, the bill requires the Office of Patient Protection to report any overturned or partially overturned denials of behavioral health care to the Division of Insurance. The Division of Insurance will then review these denials to determine if they violate federal laws like the Mental Health Parity and Addiction Equity Act (MHPAEA), which ensures equal coverage for mental health and substance use disorders compared to medical and surgical benefits, and relevant state parity laws. If a violation is found, the Division of Insurance can investigate and impose fines, with penalties increasing significantly if a pattern of violations by an insurer is discovered. The bill also directs both the Office of Patient Protection and the Division of Insurance to create regulations protecting patient information and to publicly post statistics on behavioral health reviews and any adverse determinations against insurers, thereby increasing accountability and informing consumers.