AN ACT PROHIBITING HEALTH CARE INSURERS FROM RETROACTIVELY DENYING HEALTH INSURANCE CLAIMS FOR BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES.

HB 5278 prohibits health insurance companies from retroactively denying claims or reclaiming payments for behavioral health and substance abuse services after one year from the service date, provided prior authorization was obtained and payment was made. It requires insurers to provide written notice of any denial within one year of service. This directly affects health care providers who bill for these services by ensuring payment stability after the one-year period. Exceptions apply only for fraudulent claims or services never delivered.