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House Bill 1594 |
House Author: Zerwas |
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Effective: 9-1-07 |
Senate Sponsor: Carona |
House Bill 1594 amends the Insurance Code to create an expedited credentialing process for a physician who joins an established medical group that has a current contract with a managed care plan. The bill sets out eligibility requirements for the applicant physician, authorizes the physician to collect copayments and fees from plan enrollees, requires the plan to pay the physician for services provided to enrollees as if the physician were a participating provider in the plan's network, and allows the plan to exclude the physician from any listing of its participating physicians while the application is pending. If the application is not approved, the bill allows the issuer to recover from the physician or medical group the difference between in-network and out-of-network physician payments and provides that the enrollee is not responsible for that difference. The physician or medical group may retain any copayments collected and may not charge an enrollee for any portion of the physician's fee that is not paid or reimbursed by the plan. The bill exempts an issuer who complies with these provisions from liability for damages in connection with its payments to an applicant physician and prohibits such a physician from being considered as an available primary care physician or provider by an enrollee of a health maintenance organization.