Text: HF02298 Text: HF02300 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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
Text: HF02298 Text: HF02300 Text: HF02200 - HF02299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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