House File 2299 HOUSE FILE BY FORD Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act to require certain notices regarding the external review 2 of denied health care insurance coverage. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 6235HH 80 5 kk/sh/8 PAG LIN 1 1 Section 1. Section 514J.2, Code 2003, is amended by adding 1 2 the following new subsection: 1 3 NEW SUBSECTION. 4A. "Health care services" means services 1 4 included in the furnishing to any individual of medical or 1 5 dental care, or hospitalization, or incident to the furnishing 1 6 of such care or hospitalization, as well as the furnishing to 1 7 any person of all other services for the purposes of 1 8 preventing, alleviating, curing, or healing human illness, 1 9 injury, or physical disability. 1 10 Sec. 2. Section 514J.3A, Code 2003, is amended to read as 1 11 follows: 1 12 514J.3A NOTICE. 1 13 1. When a claim is denied in whole or in part based on 1 14 medical necessity, the carrier or organized delivery system 1 15 shall provide a notice in writing to the enrollee of the 1 16 internal appeal mechanism provided under the carrier or 1 17 organized delivery system's plan or policy. 1 18 2. At the time of a coverage decision, the carrier or 1 19 organized delivery system shall notify the enrollee in writing 1 20 of the right to have the coverage decision reviewed under the 1 21 external review process. 1 22 3. Every insurance identification card, including 1 23 prescription drug information cards under chapter 514L, issued 1 24 to an enrollee in this state shall contain a telephone number 1 25 to request an external review for denied coverage pursuant to 1 26 this chapter. The notice shall be in a format approved by the 1 27 commissioner. 1 28 4. In every hospital, clinic, health care facility, or 1 29 place of business where health care services are provided in 1 30 this state, there shall be posted in a conspicuous place for 1 31 public view notice of an enrollee's right to seek external 1 32 review of denied coverage pursuant to this chapter. The 1 33 notice shall be in a format approved by the commissioner. 1 34 EXPLANATION 1 35 This bill requires certain notices to be given to enrollees 2 1 regarding the right to an external review by the insurance 2 2 commissioner of denied health insurance coverage. 2 3 The bill requires that every insurance identification card, 2 4 including prescription drug information cards, include a 2 5 telephone number to request an external review of denied 2 6 insurance coverage by the insurance commissioner. The bill 2 7 requires all hospitals, clinics, health care facilities, and 2 8 any other place of business that provides health care services 2 9 to post notices in the place of business for public view 2 10 regarding the right to request an external review of denied 2 11 insurance coverage by the insurance commissioner. The bill 2 12 defines "health care services". The insurance commissioner 2 13 shall approve the format of the notices. 2 14 LSB 6235HH 80 2 15 kk/sh/8