House File 2388 - Introduced



                                       HOUSE FILE       
                                       BY  FORD


    Passed House,  Date               Passed Senate, Date             
    Vote:  Ayes        Nays           Vote:  Ayes        Nays         
                 Approved                            

                                      A BILL FOR

  1 An Act requiring additional notice to insureds about external
  2    review of health care coverage decisions.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  4 TLSB 6347HH 81
  5 av/sh/8

PAG LIN



  1  1    Section 1.  Section 514J.3A, Code 2005, is amended to read
  1  2 as follows:
  1  3    514J.3A  NOTICE.
  1  4    1.  An insurance card issued by a carrier or organized
  1  5 delivery system for a policy or contract providing for third=
  1  6 party payment or prepayment of health or medical expenses
  1  7 subject to this section shall contain the telephone number for
  1  8 an insured to obtain more information regarding initiation of
  1  9 the external review process for coverage decisions under this
  1 10 chapter.
  1 11    2.  The telephone number for an insured to obtain more
  1 12 information regarding initiation of the external review
  1 13 process in this chapter shall also be posted in a prominent
  1 14 place in the office of a private practitioner or group of
  1 15 practitioners who are health care providers as defined in
  1 16 section 135.61, or an institutional health care facility as
  1 17 defined in section 135.61.
  1 18    3.  When a claim is denied in whole or in part based on
  1 19 medical necessity, the carrier or organized delivery system
  1 20 shall provide a notice in writing to the enrollee of the
  1 21 internal appeal mechanism provided under the carrier or
  1 22 organized delivery system's plan or policy.
  1 23    4.  At the time of a coverage decision, the carrier or
  1 24 organized delivery system shall notify the enrollee in writing
  1 25 of the right to have the coverage decision reviewed under the
  1 26 external review process.
  1 27                           EXPLANATION
  1 28    This bill amends Code section 514J.3A, relating to notice
  1 29 provisions for the external process for health care coverage
  1 30 decisions under Code chapter 514J.  The bill adds a
  1 31 requirement that the phone number for an insured to obtain
  1 32 more information about the external review process be printed
  1 33 on the insured's insurance card, and be posted in a prominent
  1 34 place in health care facilities.
  1 35 LSB 6347HH 81
  2  1 av:nh/sh/8