AN ACT CONCERNING THE BURDEN OF PROOF DURING ADVERSE DETERMINATION AND UTILIZATION REVIEW.

SB 1010 shifts the burden of proof in health insurance coverage disputes: it requires health insurance companies (health carriers) to prove that denied medical services are not medically necessary, rather than patients having to prove they are necessary. This applies specifically to "adverse determinations" (denials of coverage) and "utilization reviews" (insurance company assessments of treatment necessity). The law establishes a rebuttable presumption, meaning insurers must initially demonstrate lack of medical necessity, but patients or providers can challenge this with evidence. The bill directly affects patients denied coverage and insurers conducting coverage reviews, aiming to streamline disputes over medically necessary care.