§ 27-20-29.1 - Insurance coverage for mastectomy hospital stays. - Rhode Island Statutes

SECTION 27-20-29.1

   § 27-20-29.1  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. Every individualor group hospital or medical services plan contract delivered, issued fordelivery, or renewed in this state shall provide coverage for a minimumforty-eight (48) hour time period in a hospital after the surgical proceduresknown as a mastectomy, and a minimum twenty-four (24) hours after an axilarynode dissection. Any decision to shorten this minimum coverage shall be made bythe attending physician in consultation with and upon agreement by the patient.If the patient participates in an early discharge, defined as in-patient carefollowing a mastectomy that is less than forty-eight hours and in-patient carefollowing an axilary node dissection that is less than twenty-four (24) hours,coverage shall include a minimum of one home visit conducted by a physician orregistered nurse.

   (b) 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 23 of title 17.12. 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.

   (c) 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.