An Act Concerning The Burden Of Proof During Adverse Determination And Utilization Review.
Impact
The introduction of this bill is anticipated to enhance patient protection by making it more challenging for health carriers to deny claims for treatment based solely on their assessment of medical necessity. If passed, this bill would likely lead to a more patient-friendly environment where healthcare providers and patients can more confidently seek services without the constant fear of denial due to insurer's negative determinations.
Summary
SB01010 is a legislative proposal that aims to amend title 38a of the general statutes to establish a rebuttable presumption placing the burden of proof on health carriers regarding the necessity of health care services. Specifically, under this bill, health carriers are required to prove that certain health care services, which are subject to adverse determination or utilization review, are not medically necessary. This shift significantly impacts how health carriers defend their decisions when denying coverage for medical services.
Contention
While the bill is designed to support patients, it may prompt some debate regarding the operational burdens it could impose on health carriers. Opponents may argue that this legislation could lead to increased costs for insurers, which in turn could impact premium rates for consumers. Additionally, there might be concerns around the balance of power between health carriers and healthcare providers, particularly regarding the implications of a rebuttable presumption on the latter's practices.