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

This bill requires health insurance carriers in Massachusetts to pay for medically necessary services when providers follow the insurer's clinical guidelines and approved authorization procedures. It prevents denials based on minor administrative or technical errors, except in cases of suspected fraud, and limits the time insurers have to recoup payments to twelve months. The law also mandates that insurers provide detailed written notices before seeking payment adjustments and must conduct a retrospective review within thirty days if a denial stems from an unintentional error in obtaining authorization. Additionally, if a service is deemed medically necessary after such a review, the insurer must reverse the denial and pay the claim.