House
File
67
-
Introduced
HOUSE
FILE
67
BY
HUNTER
A
BILL
FOR
An
Act
relating
to
the
provision
of
certain
information
for
1
insureds
regarding
external
review
of
health
care
coverage
2
decisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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67
Section
1.
Section
514J.3A,
Code
2011,
is
amended
to
read
1
as
follows:
2
514J.3A
Notice
External
review
——
notice
.
3
1.
An
insurance
card
issued
by
a
carrier
or
organized
4
delivery
system
for
a
policy
or
contract
providing
for
third-
5
party
payment
or
prepayment
of
health
or
medical
expenses
6
subject
to
this
section
shall
contain
a
telephone
number
7
or
internet
site
information
for
an
insured
to
obtain
more
8
information
regarding
initiation
of
the
external
review
process
9
for
coverage
decisions
under
this
chapter.
10
2.
The
telephone
number
or
internet
site
information
for
an
11
insured
to
obtain
more
information
regarding
initiation
of
the
12
external
review
process
in
this
chapter
shall
also
be
posted
in
13
a
prominent
place
in
the
office
of
a
private
practitioner
or
14
group
of
practitioners
who
are
health
care
providers
as
defined
15
in
section
135.61,
or
an
institutional
health
care
facility
as
16
defined
in
section
135.61.
17
3.
When
a
claim
is
denied
in
whole
or
in
part
based
on
18
medical
necessity,
the
carrier
or
organized
delivery
system
19
shall
provide
a
notice
in
writing
to
the
enrollee
of
the
20
internal
appeal
mechanism
provided
under
the
carrier
or
21
organized
delivery
system’s
plan
or
policy.
22
4.
At
the
time
of
a
coverage
decision,
the
carrier
or
23
organized
delivery
system
shall
notify
the
enrollee
in
writing
24
of
the
right
to
have
the
coverage
decision
reviewed
under
the
25
external
review
process.
26
EXPLANATION
27
This
bill
amends
Code
section
514J.3A,
relating
to
notice
28
provisions
for
the
external
review
process
for
health
care
29
coverage
decisions
under
Code
chapter
514J.
The
bill
adds
30
a
requirement
that
a
telephone
number
or
internet
site
31
information
allowing
for
an
insured
to
obtain
more
information
32
about
the
external
review
process
be
printed
on
the
insured’s
33
insurance
card,
and
be
posted
in
a
prominent
place
in
health
34
care
facilities
and
health
care
provider
offices.
35
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