Insurance; medical necessity of a healthcare service; provisions

Summary

The bill changes state law so that when a private review agent or utilization review entity questions the medical necessity of a health service, an adverse decision can only be made after a clinical peer licensed in Georgia and trained in the relevant specialty agrees to it. The treating provider must be consulted first, using phone, callback, or a web system, and must receive a notice explaining the reasons for any denial. The rule applies to all insurance policies issued or renewed in Georgia on or after Jan. 1, 2027.

AI-generated summary — may be incomplete or inaccurate. Verify against the official bill text.

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