House File 659 - Introduced



                                       HOUSE FILE       
                                       BY  HUNTER


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

                                      A BILL FOR

  1 An Act relating to the provision of certain information to
  2    insureds regarding the internal appeal mechanism provided
  3    under certain health care plans or policies.
  4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
  5 TLSB 2685HH 82
  6 av/je/5

PAG LIN



  1  1    Section 1.  Section 514J.3A, Code 2007, is amended to read
  1  2 as follows:
  1  3    514J.3A  NOTICE.
  1  4    1.  When a claim is denied in whole or in part based on
  1  5 medical necessity, the carrier or organized delivery system
  1  6 shall provide a notice in writing to the enrollee of the
  1  7 internal appeal mechanism provided under the carrier or
  1  8 organized delivery system's plan or policy.
  1  9    a.  An insurance card issued by a carrier or organized
  1 10 delivery system for a policy or contract providing for
  1 11 third=party payment or prepayment of health or medical
  1 12 expenses subject to this section shall contain the telephone
  1 13 number for an insured to obtain more information regarding the
  1 14 internal appeal mechanism provided under the plan or policy of
  1 15 the carrier or organized delivery system.
  1 16    b.  The telephone number for an insured to obtain more
  1 17 information regarding the internal appeal mechanism provided
  1 18 under the plan or policy of a carrier or organized delivery
  1 19 system shall be posted in a prominent place in the offices of
  1 20 private practitioners and groups of practitioners who are
  1 21 health care providers as defined in section 135.61, and in
  1 22 institutional health facilities as defined in section 135.61.
  1 23    2.  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 internal appeal mechanism when a health
  1 30 care claim is denied by a carrier or organized delivery system
  1 31 based on medical necessity.  The bill adds a requirement that
  1 32 a telephone number allowing an insured to obtain more
  1 33 information about the internal appeal mechanism provided under
  1 34 the plan or policy of a carrier or organized delivery system
  1 35 be printed on the insured's insurance card, and be posted in a
  2  1 prominent place in health facilities and in health care
  2  2 providers' offices.
  2  3 LSB 2685HH 82
  2  4 av:nh/je/5