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1998 SESSION

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SB 224 Insurance; private review agents.

Introduced by: Walter A. Stosch | all patrons    ...    notes | add to my profiles

SUMMARY:

Insurance; private review agents. Transfers responsibility for certificating private review agents from the Virginia State Corporation Commission's Bureau of Insurance to the Department of Health. Private review agents conduct "utilization reviews" for insurers, reviewing the necessity, appropriateness and efficiency of hospital, medical or other health care resources in determining whether a service should be covered by a health care coverage plan. Persons conducting utilization reviews as employees of HMOs, health insurers and other entities offering health care coverage plans are not regulated as private review agents. Such entities, while themselves exempt from regulation as private review agents, are subject--along with their agents and employees--to the utilization review standards and appeals provisions contained in Chapter 54 (§ 38.2-5400 et seq.) of the insurance title.


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