Sec. 38a-503d. Mandatory coverage for mastectomy care. Termination of provider contract prohibited. - Connecticut Statutes

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Statutes > Connecticut > Title38a > Chap700c > Sec38a-503d

      Sec. 38a-503d. Mandatory coverage for mastectomy care. Termination of provider contract prohibited. (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state on or after July 1, 1997, shall provide coverage for at least forty-eight hours of inpatient care following a mastectomy or lymph node dissection, and shall provide coverage for a longer period of inpatient care if such care is recommended by the patient's treating physician after conferring with the patient. No such insurance policy may require mastectomy surgery or lymph node dissection to be performed on an outpatient basis. Outpatient surgery or shorter inpatient care is allowable under this section if the patient's treating physician recommends such outpatient surgery or shorter inpatient care after conferring with the patient.

      (b) No individual health insurance carrier may terminate the services of, require additional documentation from, require additional utilization review, reduce payments or otherwise penalize or provide financial disincentives to any attending health care provider on the basis that the provider orders care consistent with the provisions of this section.

      (P.A. 97-198, S. 1, 5.)

      History: P.A. 97-198 effective July 1, 1997.

      See Sec. 38a-530d for similar provisions re group policies.

State Codes and Statutes

Statutes > Connecticut > Title38a > Chap700c > Sec38a-503d

      Sec. 38a-503d. Mandatory coverage for mastectomy care. Termination of provider contract prohibited. (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state on or after July 1, 1997, shall provide coverage for at least forty-eight hours of inpatient care following a mastectomy or lymph node dissection, and shall provide coverage for a longer period of inpatient care if such care is recommended by the patient's treating physician after conferring with the patient. No such insurance policy may require mastectomy surgery or lymph node dissection to be performed on an outpatient basis. Outpatient surgery or shorter inpatient care is allowable under this section if the patient's treating physician recommends such outpatient surgery or shorter inpatient care after conferring with the patient.

      (b) No individual health insurance carrier may terminate the services of, require additional documentation from, require additional utilization review, reduce payments or otherwise penalize or provide financial disincentives to any attending health care provider on the basis that the provider orders care consistent with the provisions of this section.

      (P.A. 97-198, S. 1, 5.)

      History: P.A. 97-198 effective July 1, 1997.

      See Sec. 38a-530d for similar provisions re group policies.

State Codes and Statutes

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State Codes and Statutes

Statutes > Connecticut > Title38a > Chap700c > Sec38a-503d

      Sec. 38a-503d. Mandatory coverage for mastectomy care. Termination of provider contract prohibited. (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469 delivered, issued for delivery, amended, renewed or continued in this state on or after July 1, 1997, shall provide coverage for at least forty-eight hours of inpatient care following a mastectomy or lymph node dissection, and shall provide coverage for a longer period of inpatient care if such care is recommended by the patient's treating physician after conferring with the patient. No such insurance policy may require mastectomy surgery or lymph node dissection to be performed on an outpatient basis. Outpatient surgery or shorter inpatient care is allowable under this section if the patient's treating physician recommends such outpatient surgery or shorter inpatient care after conferring with the patient.

      (b) No individual health insurance carrier may terminate the services of, require additional documentation from, require additional utilization review, reduce payments or otherwise penalize or provide financial disincentives to any attending health care provider on the basis that the provider orders care consistent with the provisions of this section.

      (P.A. 97-198, S. 1, 5.)

      History: P.A. 97-198 effective July 1, 1997.

      See Sec. 38a-530d for similar provisions re group policies.