Creates provisions relating insurance coverage of medically necessary health care services
Impact
If passed, HB871 would significantly impact the relationship between insurance providers and healthcare service delivery in Missouri. The legislation is designed to enhance patient access to necessary medical treatments by preventing insurance companies from denying coverage based on company policy rather than medical necessity. This could improve healthcare access for many individuals and reinforce the role of healthcare professionals in making critical decisions about patient care.
Summary
House Bill 871 aims to amend Chapter 376 of the Revised Statutes of Missouri by adding a new section (376.1284) that establishes guidelines for insurance coverage of medically necessary health services. The bill mandates that health carriers and benefit plans must provide coverage for a healthcare service if at least two healthcare professionals agree that the service is medically necessary. This aims to ensure that patients receive appropriate care as deemed necessary by qualified medical professionals, facilitating better health outcomes.
Contention
The bill could promote discussions around the definitions and standards of what constitutes 'medically necessary' care, potentially leading to disagreements on coverage disputes. There may also be concerns from insurance providers about increased costs associated with the mandate, as they would be required to cover more procedures that some may consider avoidable or experimental. Additionally, the effectiveness of this bill in practice will depend on the compliance mechanisms that are put in place to enforce these new requirements.