General Assembly Proposed Bill No. 18
January Session, 2011 LCO No. 231
Referred to Committee on Insurance and Real Estate
Introduced by:
SEN. LOONEY, 11th Dist.
General Assembly
Proposed Bill No. 18
January Session, 2011
LCO No. 231
Referred to Committee on Insurance and Real Estate
Introduced by:
SEN. LOONEY, 11th Dist.
AN ACT CONCERNING APPEALS OF HEALTH INSURANCE BENEFITS DENIALS.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
That title 38a of the general statutes be amended to (1) specify a presumption of medical necessity for appeals reviewed by review entities on behalf of the Insurance Commissioner pursuant to section 38a-478n of the general statutes, (2) require managed care companies, health insurers and utilization review companies to provide to providers of record and enrollees after a final determination not to certify an admission, service, procedure or extension of stay, documents and information considered in such final determination, and (3) require dispensation and coverage of a prescribed drug for the duration of any appeal of a determination not to certify such dispensation.
Statement of Purpose:
To improve the quality of health care in this state by specifying a presumption of medical necessity for appeals of health insurance benefits denials, requiring documents and information that were considered in a final determination not to certify an admission, service, procedure or extension of stay to be provided to a provider of record and to an enrollee, and requiring dispensation and coverage of a prescribed drug during an appeal of a determination not to certify such dispensation.