31A-22-628 - Standing referral to a specialist. - Utah Statutes

31A-22-628. Standing referral to a specialist.
(1) With respect to a health insurance policy or health maintenance organization contractthat does not allow an insured to have direct access to a health care specialist, the insurer shallestablish and implement a procedure by which an insured may obtain a standing referral to ahealth care specialist.
(2) The procedure established under Subsection (1):
(a) shall provide for a standing referral to a specialist if the insured's primary careprovider determines, in consultation with the specialist, that the insured needs continuing carefrom the specialist; and
(b) may require the insurer's approval of a treatment plan designed by the specialist, inconsultation 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.

Enacted by Chapter 37, 2000 General Session