§ 31A-22-628 — Standing referral to a specialist.

(1) With respect to a health insurance policy or managed care organization contract that does not allow an insured to have direct access to a health care specialist, the insurer shall establish and implement a procedure by which an insured may obtain a standing referral to a health care specialist.
(2) The procedure established under Subsection (1):

(2)(a) shall provide for a standing referral to a specialist if the insured's primary care provider determines, in consultation with the specialist, that the insured needs continuing care from the specialist; and
(2)(b) may require the insurer's approval of a treatment plan designed by the specialist, in consultation with the primary care provider and the insured, which may include:
(2)(b)(i) a limit on the number of visits to the specialist;
(2)(b)(ii) a time limit on the duration of the referral; and
(2)(b)(iii) mandatory updates on the insured's condition.

Legislative History

Amended by Chapter 292, 2017 General Session