HB 804 -- Health Carrier Notification Requirements

Sponsor:  Wilson (130)

This bill requires all health carriers to notify their enrollees
in writing or electronically or by phone when a health care
provider changes from an in-network provider to an out-of-network
provider.  Carriers must notify enrollees at least 30 business
days prior to the effective date, or as soon as possible, of the
status change and must have a written procedure that ensures
continuity of care for enrollees when network status changes
occur including notification and transfers to other in-network
providers.  If a provider changes its network status, the carrier
must provide enrollees with continuation of care for up to 90
days when medically necessary and medically prudent.  If
continuation of care is needed or if the carrier fails to notify
an enrollee 30 days prior to any network status change, the
enrollee can continue to receive services at in-network costs
from the provider who changed to out-of-network status, and the
enrollee will not be liable for any charges in excess of
in-network rates and costs.  If the in-network provider who
changed network status is authorized to provide continuation of
care to an enrollee, the carrier must reimburse the provider at
in-network rates.

Missouri House of Representatives
95th General Assembly, 1st Regular Session
Last Updated November 17, 2009 at 9:25 am