Text: SF02068 Text: SF02070 Text: SF02000 - SF02099 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514F.6 STANDING REFERRAL.
1 2 1. A third-party payor shall not deny coverage for
1 3 services provided by a specialist which are covered under a
1 4 policy or contract or plan provided by the third-party payor
1 5 solely because such services are provided under a standing
1 6 referral given to the patient by the patient's primary care
1 7 physician.
1 8 2. For purposes of this section, unless the context
1 9 otherwise requires:
1 10 a. "Physician" means a person who is licensed under
1 11 chapter 148, 150, or 150A.
1 12 b. "Standing referral" means a referral given by a
1 13 physician to a patient to see a specialist. Such referral is
1 14 deemed to permit the patient to see the specialist under the
1 15 referral as deemed necessary by the patient.
1 16 c. "Third-party payor" means a carrier, as defined in
1 17 section 513B.2; an organized delivery system authorized under
1 18 1993 Iowa Acts, chapter 158, and licensed by the director of
1 19 public health; or a plan established pursuant to chapter 509A
1 20 for public employees.
1 21 EXPLANATION
1 22 This bill provides that a third-party payor shall not deny
1 23 coverage for services provided by a specialist which are
1 24 covered under a policy or contract or plan provided by the
1 25 third-party payor if such services are provided under a
1 26 standing referral given to the patient by the patient's
1 27 primary care physician. The bill defines "standing referral"
1 28 as a referral given by a physician to a patient to see a
1 29 specialist, and that is deemed to permit the patient to see
1 30 the specialist under the referral as deemed necessary by the
1 31 patient.
1 32 LSB 5214XS 78
1 33 mj/cls/14
Text: SF02068 Text: SF02070 Text: SF02000 - SF02099 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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