Senate Bill No. 108
(By Senators McKenzie, Minard, Redd, Facemyer, Rowe and Sharpe)
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[Introduced February 15, 2001; referred to the
Committee on Banking and Insurance.]
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A BILL to amend and reenact section three, article twenty-five-c,
chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, relating to
prohibiting managed care plans from preventing subscribers
from pursuing provider-recommended treatment if a second
provider, chosen by both the managed care plan and the
subscriber, recommends the same course of treatment.
Be it enacted by the Legislature of West Virginia:
That section three, article twenty-five-c, chapter
thirty-three of the code of West Virginia, one thousand nine
hundred thirty-one, as amended, be amended and reenacted to read
as follows:
ARTICLE 25C. HEALTH MAINTENANCE ORGANIZATION PATIENT BILL OF
RIGHTS.
§33-25C-3. Notice of certain subscriber rights.
All managed care plans must provide to subscribers on a form
prescribed by the commissioner a notice of certain subscriber
rights. The notice shall address the following areas:
(1) The ability of the subscriber to pursue grievance and
hearing procedures without reprisal from the managed care plan;
(2) How the subscriber may choose providers within the plan;
(3) The subscriber's right to privacy and confidentiality;
(4) The subscriber's ability to examine and offer
corrections to their own medical records;
(5) The subscriber's right to be informed of plan policies
and any charges for which the subscriber will be responsible;
(6) The subscriber's ability to obtain evidence of the
medical credentials of a plan provider such as diploma and board
certifications;
(7) The right of subscriber's to have coverage denials
reviewed by appropriate medical professionals consistent with
plan review procedures;
(8) The subscriber's right to have coverage of medical treatment recommended by a provider: Provided, That either: (a)
The managed care plan agrees to the recommended treatment; or (b)
a second provider, chosen by both the managed care plan and the
subscriber, agrees to the recommended treatment. If the managed
care plan and the subscriber fail to agree on a second provider,
the commissioner will randomly choose a second provider;
(8) (9) Any other areas the commissioner may by rule
require.
NOTE: The purpose of this bill is to prohibit health care
insurers from preventing subscribers from pursuing provider
recommended treatment if a second provider, chosen by both the
health care insurer and the subscriber, recommends the same
course of treatment.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.
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