Amends TCA Title 56, Chapter 7.
Present law prohibits a health benefit plan from denying coverage or payment for emergency services if the symptoms presented by an enrollee of a health benefit plan and recorded by the attending provider indicate that an emergency medical condition could exist, regardless of (i) the final diagnosis of the symptoms, (ii) whether prior authorization was obtained to provide those services, and (iii) whether the provider furnishing the services has a contractual agreement with the health benefit plan for the provision of the services to the enrollee. Present law authorizes, once an enrollee is stabilized, a health benefit plan to require as a condition of further coverage that a provider promptly contact the health insurer for prior authorization for continuing treatment, specialty consultations, transfer arrangements or other medically necessary and appropriate care for an enrollee. This bill requires a health benefit plan seeking to impose such a requirement for further coverage to wait until 72 hours after an enrollee is stabilized.
Present law prohibits a health benefit plan from denying coverage or payment for emergency services if the symptoms presented by an enrollee of a health benefit plan and recorded by the attending provider indicate that an emergency medical condition could exist, regardless of (i) the final diagnosis of the symptoms, (ii) whether prior authorization was obtained to provide those services, and (iii) whether the provider furnishing the services has a contractual agreement with the health benefit plan for the provision of the services to the enrollee. Present law authorizes, once an enrollee is stabilized, a health benefit plan to require as a condition of further coverage that a provider promptly contact the health insurer for prior authorization for continuing treatment, specialty consultations, transfer arrangements or other medically necessary and appropriate care for an enrollee. This bill requires a health benefit plan seeking to impose such a requirement for further coverage to wait until 72 hours after an enrollee is stabilized.
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