HB 2359 -- 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 days prior
to the effective date 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
their 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
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:12 pm