§ 23-86-122 — Prior approval process for experimental and investigational surgical products and medical devices - Definition

(a) As used in this section: (1) "Health carrier" means a: (A) Health maintenance organization; (B) Hospital medical service corporation; and (C) Disability insurance company; (2) "Health carrier" includes a: (A) Self-insured governmental or church plan; and (B) Third-party administrator that administers or adjusts disability benefits for a disability insurer, hospital medical service corporation, health maintenance organization, self-insured governmental plan, or self-insured church plan; and (3) "Health carrier" does not include: (A) An automobile insurer paying medical or hospital benefits under § 23-89-202(1) or a self-insured employer health benefits plan; or (B) A person, company, or organization licensed or registered to issue or that issues an insurance policy or insurance contract in this state as described in §§ 23-62-102 and 23-62-104 - 23-62-107 providing medical or hospital benefits for accidental injury or disability. (b) A health carrier that excludes or denies coverage for a specific surgical product or medical device approved for marketing by the United States Food and Drug Administration as experimental or investigational, or both, shall develop a process by which a surgeon, before utilizing the surgical product or medical device, may present medical evidence to obtain a review for the individual patient for coverage of the surgical product or medical device.

Legislative History

Amended by Act 2015, No. 1164,§ 6, eff. 7/22/2015. Added by Act 2013, No. 464,§ 1, eff. 8/16/2013.