Under existing law, some entities that make decisions on health insurance claims are subject to certain requirements, including registration with the Alabama Department of Public Health. This bill would set additional minimal standards for health insurers and related entities that handle claims for coverage, including time limits for making prior authorization decisions, and appeals from coverage denials. This bill would require that insurers use physicians or other appropriately-licensed health care professionals to make coverage determinations. This bill would also require health insurers to confer "gold card" status on physicans and other health care professionals by waiving the requirement for prior authorization for payment when the physician or other health care professional demonstrates a high level of claims that meet the medical necessity requirement.

Statutes affected:
Introduced: 27-3B-1