Some health insurers may have to update the policies they use in the Nutmeg State.
Connecticut has enacted a law that establishes definitions of "medical necessity" and "medically necessary" that state-regulated individual and group health insurance policies must use in Connecticut starting Jan. 1, 2008, according to a notice from Connecticut Insurance Commissioner Thomas Sullivan.
Here are the definitions:
"'Medically necessary" or "medical necessity" means health care services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: (1) In accordance with generally accepted standards of medical practice; (2) clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury or disease; and (3) not primarily for the convenience of the patient, physician or other health care provider and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury or disease.
Connecticut also has adopted a law requiring state-regulated health insurers to apply in-network reimbursement rules for routine patient care for a cancer patient who is participating in a clinical trial in an out-of-network facility if the treatment provided through the clinical trial is not available in-network.
A copy of the Connecticut notice about the new laws is on the Web .
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.