State Codes and Statutes
Statutes > North-carolina > Chapter_58 > GS_58-3-235§ 58‑3‑235. Selection of specialist as primary care provider.
(a) Each insurer thatoffers a health benefit plan shall have a procedure by which an insureddiagnosed with a serious or chronic degenerative, disabling, or life‑threateningdisease or condition, either of which requires specialized medical care mayselect as his or her primary care physician a specialist with expertise intreating the disease or condition who shall be responsible for and capable ofproviding and coordinating the insured's primary and specialty care. If theinsurer determines that the insured's care would not be appropriatelycoordinated by that specialist, the insurer may deny access to that specialistas a primary care provider.
(b) The selection ofthe specialist shall be made under a treatment plan approved by the insurer, inconsultation with the specialist and the insured or the insured's designee andafter notice to the insured's primary care provider, if any. The specialist mayprovide ongoing care to the insured and may authorize such referrals,procedures, tests, and other medical services as the insured's primary careprovider would otherwise be allowed to provide or authorize, subject to theterms of the treatment plan. Services provided by a specialist who is providingand coordinating primary and specialty care remain subject to utilizationreview and other requirements of the insurer, including its requirements forprimary care providers. (2001‑446, s. 1.3.)
