CT makes insurers define "medical necessity"

A new Connecticut law which will make health plans define "medical necessity" in policies is headed to the state's governor for signature. In reality, the bill isn't much of a ground-breaker--insurers typically offer standard medical necessity in policies--but it comes as part of a more aggressive longer-term effort to make insurers defend their medical necessity decisions. Under the original bill, if a member appealed a rejection, the insurer would have had to demonstrate why a treatment wasn't necessary. Right now, under the current system, doctors and patients have to prove the treatment is necessary. This continues to be a cause of tremendous friction between doctors and managed care plans, with doctors taking serious issue with the standards health plans have set.

To learn more about the bill:
- read this Hartford Courant article