To require group health plans and health insurance issuers to provide independent review of adverse coverage determinations.
Requires group health plan claims procedures to include procedures for a fair, de novo determination of medical necessity by the independent review organization without regard to the definition used by the plan, as well as notifications to participants or beneficiaries of their rights to: (1) appeal adverse determinations to utilization review agents of the plan; (2) appeal adverse determinations of such utilization review agents to independent review organizations (with procedures for such appeal); and (3) obtain immediate review by an independent review organization in cases of life-threatening conditions (with procedures for obtaining such review).
Sets forth requirements for: (1) procedures for appeals of adverse decisions to the plan's utilization review agent; (2) the independent review process; and (3) certification of independent review organizations by the Secretary of Labor.
Treats the independent review organization's determination as the final decision of the plan, but allows a court to vacate or modify such determination under certain circumstances.
Introduced in House
Introduced in House
Referred to the House Committee on Education and the Workforce.
Referred to the Subcommittee on Employer-Employee Relations.
checking server…
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line