Senate Bill No. 373
(By Senators McKenzie, Walker, Hunter,
Prezioso, Redd, Mitchell, Minear, McCabe, Ball, Bowman, Minard
and Kessler)
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[Introduced February 2, 2000;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.