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1996 SESSION

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HB 442 Accident and sickness insurance; access to ob/gyn services.

Introduced by: Gladys B. Keating | all patrons    ...    notes | add to my profiles

SUMMARY:

Accident and sickness insurance; access to obstetrician-gynecologists. Requires health insurers (including HMOs), providing obstetrical and gynecological services under their policies or plans, to permit females (age 13 and older) to have direct access to obstetrical-gynecological services, without the necessity of prior referral, if the provider is authorized to provide services under the policy, etc., and the provider is selected by the woman. The participating obstetrician-gynecologist may be required by the health insurer to notify, in writing, the primary care provider of any self-referred visit and to include in this notice a description of the rendered services. The services covered by this exception from prior authorization include (i) an annual wellness examination; and (ii) routine health care services incident to and rendered during an annual visit. Additional services may be provided if there is consultation between the primary care physician for follow-up care or subsequent visits; prior consultation and authorization by the PCP, including a visit to the PCP, if determined necessary by the PCP, before the patient may be directed to another specialty provider; and prior authorization by the insurer, etc., for proposed inpatient hospitalization or outpatient surgical procedures. The term, "health care services" is defined to include the recommendations of the American College of Obstetricians and Gynecologists and the services of nurse practitioners, physician's assistants, and certified nurse midwives in collaboration with the obstetrician-gynecologists. Notice of these requirements must be given. These requirements will apply any time there is a delivery, reissuance, renewal, extension of when the terms of any policy, etc., is changed or the premium adjusted.


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