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REFERENCE TITLE: insurance; health care; disclosures; information |
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State of Arizona Senate Fiftieth Legislature Second Regular Session 2012
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SB 1346 |
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Introduced by Senator Melvin
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AN ACT
amending title 20, chapter 2, article 1, Arizona Revised Statutes, by adding section 20‑238; Amending title 32, chapter 32, article 1, Arizona Revised Statutes, by adding section 32-3215; relating to health care information.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 2, article 1, Arizona Revised Statutes, is amended by adding section 20-238, to read:
20-238. Health care insurers; disclosure of information
A. With respect to a specific medical service or course of treatment, a health care insurer or self-insured health plan shall provide a summary of an insured's coverage to the insured or that person's agent within three business days after it receives the request. The summary shall include:
1. The estimated total and type of out-of-pocket costs that the insured may incur, including deductibles, copayments, coinsurance and items and other charges that are not covered by the health care insurer or self‑insured health plan.
2. An estimate of the amount that the health care insurer or self‑insured health plan paid to a provider or providers for the specific medical procedure or course of treatment. The estimate under this paragraph may provide the payment amount or rate in a manner that protects the health care insurer's proprietary pricing, but shall be a reasonable estimate of the actual amount or rate paid.
3. Whether the cost of the service or course of treatment exceeds the allowable charge under the health care insurer's or self-insured health plan's guidelines for payment for the service or course of treatment under the insured's health care plan or self-insured health plan. To receive this information, the insured must provide to the health care insurer or self‑insured health plan the applicable medical code or codes for the service or course of treatment provided or proposed to be provided.
4. A statement that the information in the summary:
(a) Is based on the information relating to the estimate of the charge that was provided to the insured or insured's agent pursuant to section 32‑3215.
(b) Represents only an estimate and is not a legally binding contract or guarantee of the amounts provided in the summary.
B. The health care insurer or self‑insured health plan shall:
1. Provide the information required pursuant to subsection A of this section in writing, orally or electronically as directed by the insured.
2. Make a good faith effort to provide accurate information to the insured pursuant to this section.
Sec. 2. Title 32, chapter 32, article 1, Arizona Revised Statutes, is amended by adding section 32-3215, to read:
32-3215. Disclosure requirements; estimate of charges
A. If a patient is recommended to, referred to or under the care of a health professional or a group of health professionals for a health care service, including any applicable course of treatment, diagnostic test or procedure, and if the patient or the patient's agent requests an estimate of the charge, the health professional or group of health professionals must provide the patient or the patient's agent with an estimate of the charge for that service.
B. A health professional or a group of health professionals must provide to the patient or the patient's agent an estimate of total charges relating to treatment within three business days after receiving the request.
C. An estimate of the charge provided pursuant to this section:
1. Must represent the good faith effort of a health professional or the group of health professionals to provide accurate information to the patient or the patient's agent.
2. Must include any discounts or financial incentives the health professional or group of health professionals is willing to offer to the patient for obtaining a health care service, diagnostic test or procedure from the health professional or group of health professionals.
3. Must include a description of the health care service, diagnostic test or procedure that includes the appropriate medical code or codes that will enable the patient or patient's agent to obtain applicable coverage payment information from a health care insurer or self-insured health plan.
4. Must include the identity of the health professional or the individual identities of the group of health professionals, if applicable, and the address of the facility with which each health professional is associated.
5. If requested by the patient or the patient's agent, may be issued electronically.
6. Is not a binding or implied contract on the parties and is not a guarantee that the amounts estimated will be charged.