SENATE DOCKET, NO. 381 FILED ON: 1/16/2013
SENATE . . . . . . . . . . . . . . No. 453
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Thomas P. Kennedy
_______________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the passage of the accompanying:
An Act to further define adverse determinations by insurers.
_______________
PETITION OF:
Name: | District/Address: |
Thomas P. Kennedy | Second Plymouth and Bristol |
SENATE DOCKET, NO. 381 FILED ON: 1/16/2013
SENATE . . . . . . . . . . . . . . No. 453
By Mr. Kennedy, a petition (accompanied by bill, Senate, No. 453) of Thomas P. Kennedy for legislation to further define adverse determinations by insurers. Financial Services. |
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE
SENATE
, NO. 434 OF 2011-2012.]
The Commonwealth of Massachusetts
An Act to further define adverse determinations by insurers.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
Section 12 (a) of Chapter 176O is amended by adding at the end thereof after the word “provider” the following new sentence:
Provided however, that in making said adverse determination, the carrier or its designated utilization review organization shall defer to the judgment of the treating clinician unless there is a preponderance of evidence that the requested admission, continued stay or other health care service does not meet the requirements for coverage based on medical necessity, appropriateness of health care setting and level of care, or effectiveness.
