AB 510 (Addis, D-San Luis Obispo)

AB 510 would establish a peer-to-peer review process that would authorize a provider to request review of a health care service plan’s or insurer’s decision that delays, denies, or modifies health care service based on medical necessity. The bill would provide that a peer physician — or, in specified circumstances, other peer-licensed health care professional — conduct the review. The bill would also require that reviews occur within two business days of the request or more timely as needed based on the enrollee’s condition. Additionally, if the plan fails to meet the review timelines, the service shall be deemed approved, superseding any prior delay, denial, or modification.   

Assembly Health Committee Support Letter

Assembly Appropriations Committee Support Letter