Bill > H573

This bill aims to further regulate the pre-authorization of medical and healthcare services by health insurance carriers. It amends Chapter 176O of the Massachusetts law to require carriers to pay claims for any medical or healthcare services that received prior approval (pre-authorization) from the carrier, with a few exceptions. These exceptions include situations where the patient was not covered at the time of service, the claim was submitted late, the patient exceeded their policy benefits after the pre-authorization was issued, the pre-authorization was based on inaccurate or incomplete information, the provider failed to substantially perform the authorized service, or the service was related to a pre-existing condition that was excluded from coverage. The bill also specifies that it does not prohibit carriers from denying continued or extended coverage as part of a concurrent review process.

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https://malegislature.gov/Bills/190/H573