§ 27-18-40 - Insurance coverage for mastectomy hospital stays. - Rhode Island Statutes

SECTION 27-18-40

   § 27-18-40  Insurance coverage formastectomy hospital stays. – (a) The Rhode Island general assembly recognizes that breast cancer is a uniqueillness with both a physical and emotional impact on patients. Except asotherwise provided, every individual or group hospital or medical services plancontract delivered, issued for delivery, as renewed in this state shall providecoverage for a minimum forty-eight (48) hour time period in a hospital afterthe surgical procedures known as a mastectomy, and a minimum twenty-four (24)hours after an axilary node dissection.

   (b) This section shall not apply to insurance coverageproviding benefits for: (1) hospital confinement indemnity; (2) disabilityincome; (3) accident only; (4) long term care; (5) Medicare supplement; (6)limited benefit health; (7) specified disease indemnity; (8) sickness or bodilyinjury or death by accident or both, and (9) other limited benefit policies.Any decision to shorten these minimum coverages shall be made by the attendingphysician in consultation with and upon agreement by the patient. If thepatient participates in an early discharge, defined as in-patient carefollowing a mastectomy that is less than forty-eight (48) hours and in-patientcare following an axilary node dissection that is less than twenty-four (24)hours, coverage shall include a minimum of one home visit conducted by aphysician or registered nurse.

   (c) Any subscriber who is aggrieved by a denial of benefitsto be provided under this section may appeal the denial in accordance withregulations of the department of health, which have been promulgated pursuantto chapter 17.12 of title 23. No policy or plan covered under this chaptershall terminate the services, reduce capitation payment, or penalize anattending physician or other health care provider who orders care consistentwith the provisions of this section.

   (d) All plans subject to this section shall provide notice toeach enrollee:

   (1) In the next mass mailing made by the plan to theemployee; or

   (2) As part of any informational packet sent to the enrollee.