DE HB216

Prohibits health insurers from unreasonably denying coverage for medical procedures or tests deemed not medically necessary.

Creates a presumption that a denial is unreasonable if an insured pays out-of-pocket after exhausting the insurer's approval process and the procedure is later proven medically necessary.

Requires insurers found in violation to reimburse the insured 100% of all expenses plus out-of-pocket costs (deductibles, co-pays, coinsurance) and any damages from delayed care.

Establishes that three or more violations within 36 months constitutes an unfair insurance practice subject to enforcement by the Insurance Commissioner under existing procedures in Section 2307.