What HB 1236 does: Requires that when an insurer denies coverage based on medical necessity, a Georgia-licensed clinical peer with training in a related specialty must affirmatively agree to the denial. Current law allows insurers to deny care after a discussion with a clinical peer; HB 1236 requires the clinical peer to sign off on the decision. The bill also requires reviewers to attempt to contact the treating provider before issuing a denial.
Consumer impact: Georgians whose insurance companies deny coverage for medical treatment would gain a stronger safeguard. Requiring a Georgia-licensed specialist to agree to the denial, rather than simply participate in a discussion, adds a meaningful check on insurer decisions. Patients and providers would also receive clearer explanations for denials, supporting more effective appeals.