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Bill

SB 363

Health care coverage: independent medical review.

2025-2026 Regular Session Introduced by Josh Becker and 4 co-sponsors

SB 363 establishes independent medical review process for California health insurance coverage decisions, allowing patients to challenge insurer denials through third-party evaluation.

August 29 hearing postponed by committee.
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Bill Summary · SB 363

Legislative bill overview

SB 363 establishes an independent medical review process for California health insurance coverage decisions. The bill appears to create a mechanism for patients to challenge insurance denials or coverage limitations through an independent third-party evaluation, separate from the insurer's initial determination.

Why is this important

Insurance coverage denials can prevent patients from accessing necessary treatments, and independent review processes can help resolve disputes between patients and insurers. This bill directly affects millions of Californians with health insurance by potentially providing an additional avenue to challenge coverage decisions, which could impact both patient access to care and insurer administrative costs.

Potential points of contention

  • Cost allocation: Whether insurers, patients, or the state bear the costs of independent reviews could significantly affect implementation and accessibility
  • Review standards and timelines: Disagreement over what medical criteria independent reviewers must apply and how quickly reviews must be completed to ensure timely patient access to care
  • Scope of reviewable decisions: Whether the process covers all coverage denials or only specific types (experimental treatments, prior authorization denials, etc.), affecting its practical reach

Compiled from official sources — confirm details with the bill’s official record.

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