General Bill
Health Care Management:
Prohibits insurers from engaging in actions encouraging insureds not to make payments before medical service is rendered; provides additional circumstances in which health insurer may not retroactively deny claims; requires claimants whose claims are denied for failure to obtain authorization to be provided opportunity to appeal; requires insurers to reverse denials under specified circumstances; requires insurers to submit written justification for determination that service was not medically necessary; prohibits health insurers or HMO's from modifying policies or procedures that would affect underlying contract terms without written mutual agreement; provides additional circumstances in which HMO's may not retroactively deny claims; requires HMO's to conduct retrospective reviews of medical necessity of service under specified circumstances; requires HMO's to submit written justification for determination that service was not medically necessary & provide process for appealing determination; prohibits HMO's from engaging in actions encouraging subscribers not to make payments before medical service is rendered; creates study group to evaluate increases in patient's financial responsibility for hospital services; provides for per diem & travel expenses; requires final report to Legislature.
Effective Date:
July 1, 2009
Last Event:
Died in Insurance, Business & Financial Affairs Policy Committee on Saturday, May 2, 2009 12:00 AM
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Subject
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Relationship
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Bill #:
SB 416
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Subject:
Health Care Management [CPSC]
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Relationship:
Similar
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