Leading legislative reforms to improve transparency of patient reviews
Ch. 224 Section 199 – Enhanced transparency of health insurance medical necessity and clinical review policies.
Insurers act as the financial gateway to almost all health care services provided within the Commonwealth. Each company uses a set of policies and criteria to determine when they will provide or deny an enrollee coverage for a service recommended by their health care provider. Such policies can dramatically influence a patient’s care, yet they have remained largely unknown to patients and their caregivers. The legislation took an important step by requiring all clinical and medical necessity policies be made available and easily accessible to enrollees and care providers. Just another example of the many important reforms—championed by the government relations team at Donoghue Barrett & Singal—that can streamline inefficiencies in the health care system and improve the patient experience.
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