AI-generated summary, not yet reviewed by Better Utah staff. Please consult the bill text.

Health insurers in Utah would face new transparency, timeliness, and consumer-protection rules for the "preauthorization" process, which requires patients to get an insurer's approval before receiving certain drugs, devices, or services; insurers would have to publicly post their preauthorization requirements, approval and appeal statistics, and whether they use artificial intelligence to review authorization requests, and disclose any AI use to the Insurance Department, network providers, and enrollees. Insurers would generally have to decide standard requests within seven calendar days, urgent care requests within 72 hours, and follow specific timelines when additional information is needed. Approved authorizations for chronic or long-term conditions would have to remain valid for at least 12 months, and outpatient services for at least six months, with limited exceptions such as when a drug proves ineffective, a better or cheaper alternative becomes available, or the drug loses coverage. Denial notices would have to list which billing codes were approved or denied, reviewers denying claims would have to use independent medical judgment rather than relying solely on outside recommendations, insurers would generally have to pay contracted providers for authorized services except in specific situations (such as a provider no longer being in-network or the patient losing eligibility), and insurers would report more detailed authorization data—including prescription drug statistics and average processing times—to the Insurance Department, with these changes taking effect January 1, 2027.