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

Utah Statutes

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

Utah § 31A-22-628

Title 31AInsurance Code

Ch. 31A-22Contracts in Specific Lines

Part 31A-22-6Accident and Health Insurance

This text of Utah § 31A-22-628 (Standing referral to a specialist.) is published on Counsel Stack Legal Research, covering Utah primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Utah Code Ann. § 31A-22-628 (2026).

Text

(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;

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(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.