New Nevada Guidance: Limits on Denials for Medically Necessary Cancer Biomarker Tests

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NV| The Nevada Division of Insurance Bulletin 26-001 clarifies that, effective October 1, 2023, Nevada health insurers must provide coverage for medically necessary biomarker testing for the diagnosis, treatment, management, and ongoing monitoring of cancer when supported by medical and scientific evidence, regardless of whether policy language has been updated to reflect this requirement. If prior authorization is required, insurers must respond within 24 hours for urgent requests and within 72 hours for all other requests. Health carriers may deny coverage for biomarker testing only if it is performed for screening purposes, by a provider for whom such testing is outside their scope of practice, by an out-of-network provider or facility, or if it has not been determined medically necessary by an appropriately qualified provider, and the Division of Insurance will monitor compliance to ensure consumers receive required testing.

Click here to see NV Bulletin 26-001

  • Bulletin
  • Nevada
  • Department of Insurance

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