House Journal: Page 1269: Wednesday, April 14, 1999

14   payor, "ordinary care" means that degree of care that

15   a person of ordinary prudence in the same profession,
16   specialty, or area of practice as such person would
17   use in the same or similar circumstances.
18     11.  "Organized delivery system" means an organized
19   delivery system as licensed by the director of public
20   health.
21     12.  "Physician" means an individual licensed under
22   chapter 148, 150, or 150A to practice medicine and
23   surgery, osteopathy, or osteopathic medicine and
24   surgery.
25     13.  "Third-party payor" means a health insurance
26   carrier, health maintenance organization, managed care
27   entity, or organized delivery system.
28     Sec.     . NEW SECTION.  514K.3  THIRD-PARTY PAYOR
29   DUTY TO EXERCISE ORDINARY CARE - LIABILITY.
30     1.  A third-party payor has the duty to exercise
31   ordinary care when making health care treatment
32   decisions and is liable for damages for harm to an
33   insured or enrollee proximately caused by the third-
34   party payor's failure to exercise such ordinary care.
35     2.  A third-party payor is also liable for damages
36   for harm to an insured or enrollee proximately caused
37   by the health care services treatment decisions made
38   by an employee, agent, or representative of the third-
39   party payor who is acting on behalf of the third-party
40   payor and over whom the third-party payor has the
41   right to exercise influence or control or has actually
42   exercised influence or control if such decision
43   results in the failure to exercise ordinary care.
44     3.  It is a defense in an action brought pursuant
45   to this section against a third-party payor that
46   neither the third-party payor, nor an employee, agent,
47   or representative of the third-party payor controlled,
48   influenced, or participated in the health care
49   services treatment decision; or that the third-party
50   payor did not deny or delay payment for any health
Page 3
 1   care services prescribed or recommended by a health
 2   care provider to the insured or enrollee.
 3     4.  Subsections 1 and 2 do not create an obligation
 4   on the part of the third-party payor to provide any
 5   health care services to an insured or enrollee that
 6   are not covered by the health care plan offered by the
 7   third-party payor.
 8     5.  This chapter does not create any liability on
 9   the part of an employer or an employer group
10   purchasing organization that purchases health care
11   services coverage or assumes risk on behalf of its
12   employees for providing health care services.

© 1999 Cornell College and League of Women Voters of Iowa

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