HB 2435 -- Payment of Insurance Claims

Sponsor:  Lembke

This bill requires the notice of the status of a claim that
includes a request for additional information from a health
carrier or third-party contractor to specify the information
requested and from whom it is requested, such as the claimant,
the patient, or another health care provider.

If a health carrier fails to pay or deny a claim within 40
processing days from receipt, in addition to monthly interest
due, the carrier must pay the claimant an amount equal to 50% of
the claim not to exceed $100 per day.  Currently, the maximum
amount is $20 per day.  The penalty will cease if the health
carrier pays or denies the claim.

The Department of Insurance, Financial Institutions, and
Professional Registration will monitor denials of claims; and if
it is determined that a health carrier acted unreasonably in
denying a claim, the department will require the carrier to pay a
penalty of $1,000 for each claim.  If a denied claim does not
include a specific reason for denial, the claim will not be
considered denied.

The additional administrative penalties for noncompliance which
the department director can assess are increased from $25 to $500
per claim and the total aggregate penalty amount from $250,000 to
$5 million.

Missouri House of Representatives
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:12 pm