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2014 SESSION

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HB 1185 Health insurance; coverage for mental health services.

Introduced by: Lionell Spruill, Sr. | all patrons    ...    notes | add to my profiles

SUMMARY AS INTRODUCED:

Health insurance; coverage for mental health services. Prohibits an insurer that provides coverage for inpatient and partial hospitalization mental health and substance abuse services for a family member of the insured or subscriber from denying coverage based primarily on a subjective evaluation of the imminence of the individual's suicide risk or risk of danger to others made by an employee or contractor of the insurer or corporation. An insurer's determination of whether inpatient treatment is medically necessary is required to give due consideration to the treatment recommendation of the health care provider treating the individual. In addition, the measure provides that if an insurer validly denies coverage for inpatient and partial hospitalization because a less intensive treatment option represents the medically necessary level of care, and the covered individual nevertheless receives the more intensive treatment, the insurer shall provide coverage for the more intensive treatment on the basis of the reimbursement and payment rates that would have applied had the less intensive treatment been provided.


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