Health insurance; expedited external review of adverse coverage decisions, cancer treatments. (HB435)

Introduced By

Del. David Yancey (R-Newport News) with support from co-patron Del. Lee Carter (D-Manassas)

Description

Expedited external review of adverse health insurance coverage decisions; cancer treatments. Provides that if an independent review organization conducting an expedited external review fails to make a decision to uphold or reverse a health insurer's adverse determination or final adverse determination regarding coverage for treatment of cancer of the covered person within 72 hours after receiving an eligible request for an expedited external review, the organization shall be deemed to have reversed the adverse determination or final adverse determination denying coverage for the cancer treatment. The measure also provides that if an independent review organization conducts an external review of an experimental or investigational treatment for the cancer of a covered person and fails to make a decision to uphold or reverse the health insurer's determination within the 20-day period allowed for making a decision after receiving opinions from clinical reviewers, the organization shall be deemed to have reversed the insurer's determination denying coverage for the experimental or investigational cancer treatment. Read the Bill »

Outcome

History