31A-22-628. Standing referral to a specialist.
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/ut/title-31a/chapter-22/31a-22-628·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Effective 5/9/2017
31A-22-628. Standing referral to a specialist.
(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):
(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
(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:
(i)a limit on the number of visits to the specialist;
(ii)a time limit on the duration of the referral; and
(iii)mandatory updates on the insured's condition.
Amended by Chapter 292 , 2017 General Session