Can insurers elect not to provide verification at all?
The SB 418 statutory language makes clear that all carriers subject to SB 418 must make a good faith effort to entertain requests for verification rather than adopting a corporate policy of no verifications. If the carrier is unable to verify, it may decline so long as it states the specific reason for the declination. Such reason, according to the statute, must be specific to the request for the proposed service rather than a blanket refusal. Q: A doctor called for verification for a cholecystectomy (gall bladder removal). While performing that procedure, the doctor discovered a severely inflamed diverticulum on the patient’s intestine that required removal in order to prevent rupture. Will the verification include the intestinal surgery? A: The SB 418 rules say the provider can furnish a description of the proposed procedure(s) or the procedure code(s). The verification and preauthorization procedures are prospective in nature. The statute and rules provide no method or procedure for
