Bill > H563

This bill aims to prevent inappropriate denials for medically necessary services. It requires insurance carriers to pay for health care services ordered by the treating provider if the services are covered under the insured's plan and follow the carrier's clinical review criteria. The bill also limits the timeframe for carriers to recoup payments for claims, prohibiting recoupment more than 90 days after the original payment if the provider can document verifying the insured's eligibility at the time of service. Additionally, the bill prohibits recouping payments if the services were previously deemed medically necessary or the manner of access or provision was previously approved by the carrier.

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https://malegislature.gov/Bills/190/H563