Mo. Rev. Stat. § 354.618. Open referral health plans offered, when–definitions–obstetrician/gynecologist services to be offered, when–eye care providers, discrimination against, prohibited–exemptions: Community-Based Health Maintenance Organizations – Missouri

Status: Enacted
Year Enacted: 1997
Year Amended: 1999
File: Download

A health carrier shall have a procedure by which a female enrollee may seek the health care services of an obstetrician/gynecologist at least once a year without first obtaining prior approval from the enrollee’s primary care provider if the benefits are covered under the enrollee’s health benefit plan, and the obstetrician/gynecologist is a member of the health carrier’s network. In no event shall a health carrier be required to permit an enrollee to have health care services delivered by a nonparticipating obstetrician/gynecologist. An obstetrician/gynecologist who delivers health care services directly to an enrollee shall report such visit and health care services provided to the enrollee’s primary care provider. A health carrier may require an enrollee to obtain a referral from the primary care physician, if such enrollee requires more than one annual visit with an obstetrician/gynecologist.


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