An Act to prevent inappropriate denials by insurers for medically necessary services

This bill requires health insurers to cover medically necessary services ordered by a treating provider that follow the insurer's clinical criteria, preventing denials based solely on administrative errors like missing authorizations. Insurers cannot deny claims for technical issues (except suspected fraud) and must stop recouping payments after 12 months (or 90 days for retroactively terminated coverage), with providers getting 30 days to challenge any recoupment. If a claim is denied due to missing authorization, insurers must conduct a 30-day retrospective review; if the service is deemed medically necessary, they must reverse the denial and pay. The law directly affects insurers and healthcare providers by standardizing claim handling and appeal processes for covered services.