H.F. 67 Section 1. Section 514J.3A, Code 2011, is amended to read 1 as follows: 2 514J.3A Notice External review —— notice . 3 1. An insurance card issued by a carrier or organized 4 delivery system for a policy or contract providing for third- 5 party payment or prepayment of health or medical expenses 6 subject to this section shall contain a telephone number 7 or internet site information for an insured to obtain more 8 information regarding initiation of the external review process 9 for coverage decisions under this chapter. 10 2. The telephone number or internet site information for an 11 insured to obtain more information regarding initiation of the 12 external review process in this chapter shall also be posted in 13 a prominent place in the office of a private practitioner or 14 group of practitioners who are health care providers as defined 15 in section 135.61, or an institutional health care facility as 16 defined in section 135.61. 17 3. When a claim is denied in whole or in part based on 18 medical necessity, the carrier or organized delivery system 19 shall provide a notice in writing to the enrollee of the 20 internal appeal mechanism provided under the carrier or 21 organized delivery system’s plan or policy. 22 4. At the time of a coverage decision, the carrier or 23 organized delivery system shall notify the enrollee in writing 24 of the right to have the coverage decision reviewed under the 25 external review process. 26 EXPLANATION 27 This bill amends Code section 514J.3A, relating to notice 28 provisions for the external review process for health care 29 coverage decisions under Code chapter 514J. The bill adds 30 a requirement that a telephone number or internet site 31 information allowing for an insured to obtain more information 32 about the external review process be printed on the insured’s 33 insurance card, and be posted in a prominent place in health 34 care facilities and health care provider offices. 35 -1- LSB 1737HH (1) 84 av/rj 1/ 1