Provides that a non-network pharmacy that provides causally related medications to a claimant shall be entitled to payment at the network rate negotiated between the carrier and the pharmacy network if the carrier's network provides mail order service or is located within a reasonable distance from the claimant; reduces costs of treatment by requiring out of network providers accept payment at the carrier's negotiated network rate, while at the same time allowing injured workers to obtain treatment in a timely manner by providing for payment to the provider when they do not obtain the treatment within the network; provides that any special diagnostic tests, x-ray examinations, magnetic resonance imaging or other radiological examinations or tests costing more than one thousand dollars performed by a provider who is not a member of the carrier's, self insured's or state insurance fund's diagnostic networks, shall be entitled to payment at the negotiated network rate.
Provides that a non-network pharmacy that provides causally related medications to a claimant shall be entitled to payment at the network rate negotiated between the carrier and the pharmacy network if the carrier's network provides mail order service or is located within a reasonable distance from the claimant; reduces costs of treatment by requiring out of network providers accept payment at the carrier's negotiated network rate, while at the same time allowing injured workers to obtain treatment in a timely manner by providing for payment to the provider when they do not obtain the treatment within the network; provides that any special diagnostic tests, x-ray examinations, magnetic resonance imaging or other radiological examinations or tests costing more than one thousand dollars performed by a provider who is not a member of the carrier's, self insured's or state insurance fund's diagnostic networks, shall be entitled to payment at the negotiated network rate.
Requests the Department of Insurance to study the impact on automobile insurance rates when bodily injury claimants submit medical treatment claims for accident-related injuries to out-of-network providers rather than in-network providers
Allows dental provider networks, certain health and hospital service corporations, and health care plans to enter into a third-party network contract to provide access to care services and discounted rates of a provider under a provider network contract.
Allows for treatment costing less than $1,500 to be done without prior approval, and more clearly defines the list of "pre-authorized procedures" as a floor on treatment as opposed to its current status as a ceiling; allows non-network providers of testing to be compensated at the provider network rate negotiated by the carrier.
Allows for treatment costing less than $1,500 to be done without prior approval, and more clearly defines the list of "pre-authorized procedures" as a floor on treatment as opposed to its current status as a ceiling; allows non-network providers of testing to be compensated at the provider network rate negotiated by the carrier.