DE HB367

Prohibits health insurers, health service corporations, and health maintenance organizations from unreasonably denying coverage for medical procedures or tests based on medical necessity determinations.

Creates a presumption that a denial is unreasonable if an insured pays out-of-pocket for a procedure or test and it is later proven to be medically necessary based on results or diagnosed medical condition.

Requires insurers found to have unreasonably denied coverage to reimburse the insured 100% of all expenses incurred for the procedure or test.

Mandates reimbursement of all out-of-pocket expenses including deductibles, co-pays, and coinsurance that the insured would have been responsible for under their health benefit plan.

Makes insurers liable for any damages sustained by the insured due to delays in obtaining the procedure or test resulting from the unreasonable denial of coverage.