AN ACT RELATING TO INSURANCE -- BENEFIT DETERMINATION AND UTILIZATION REVIEW ACT

HB 5862 requires insurance companies to prove that a healthcare service or procedure is not medically necessary before denying coverage. This directly affects patients seeking care and insurers who must justify denials of services authorized by their healthcare providers. The bill creates a presumption that any service a provider authorizes is medically necessary, shifting the burden of proof from patients to insurers. If passed, insurers would need to provide specific justification for denials rather than relying on general policy reasons.