Health insurance companies can now only take back or deny payment for previously paid claims within 18 months of paying them, and only if they give the provider written notice of why—this protects providers from surprise claim denials years later. The rule has exceptions for claims involving fraud, waste, abuse, or claims involving other insurance types like Medicare, Medicaid, workers' compensation, or when a provider was already paid for the same service. The Division of Insurance will enforce this new requirement.
The amendment dramatically shortens the recoupment period from six years to eighteen months and eliminates an entire dispute resolution process, instead requiring providers to simply refund payments within six months unless they claim an exception applies. This substantially STRENGTHENS the bill's original purpose by making it much harder for health carriers to recoup old claims and removing the multi-step arbitration procedure that previously allowed providers to challenge denials.
This amendment converts the bill from its engrossed form to its enrolled (final passed) form, which involves only formatting and administrative changes such as updating the section number from 26.170.36 to 26.170.37 and adding standard legislative certification pages—no changes to the bill's substantive content limiting health carriers' ability to recoup claims within eighteen months.
Signed by the Governor H.J. 579
Delivered to the Governor H.J. 546
Signed by the President S.J. 506
Signed by the Speaker H.J. 529
Senate Do Pass Amended Passed, YEAS 34, NAYS 0. S.J. 461
Health and Human Services Certified uncontested, placed on consent S.J. 25
Health and Human Services Do Pass Passed, YEAS 7, NAYS 0. S.J. 25
Health and Human Services Scheduled for hearing
First read in Senate and referred to Senate Health and Human Services S.J. 357
House of Representatives Do Pass Amended Passed, YEAS 67, NAYS 0. H.J. 390
Commerce and Energy Do Pass Amended Passed, YEAS 12, NAYS 1.
Commerce and Energy Motion to amend
Commerce and Energy Scheduled for hearing
First read in House and referred to House Commerce and Energy H.J. 218
Prime sponsor · Rep.
R
Prime sponsor · Sen.
R
Do Pass Amended
Health and Human Services — Do Pass
Do Pass Amended
Commerce and Energy — Do Pass Amended