An Act relative to external reviews and patient protection

HD 1278 requires that external medical reviews (for insurance coverage disputes) in Massachusetts be conducted by a licensed Massachusetts physician certified in the relevant specialty. This physician must identify themselves to the patient, provide a written report with peer-reviewed sources, conduct physical exams when needed, and carry malpractice insurance. Patients can appeal review decisions in court and, if successful, recover attorney fees and costs from the insurance company. The bill directly affects patients seeking coverage appeals and the insurance companies (risk-bearing organizations) that conduct these reviews.