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

HB 7942 requires insurance companies to prove that a healthcare service or procedure is not medically necessary before denying coverage. This directly affects patients seeking medical care and insurers conducting coverage reviews. The bill shifts the burden of proof from patients to insurers during utilization reviews, mandating that insurers justify denials with medical evidence. It aims to prevent arbitrary coverage denials by making insurers demonstrate medical necessity for each service request.