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Utah Code Title 31A. Insurance Code § 31A-22-628. Standing referral to a specialist

Current as of May 05, 2022 | Updated by FindLaw Staff

(1) With respect to a health insurance policy or managed care organization contract that does not allow an insured to have direct access to a health care specialist, the insurer shall establish and implement a procedure by which an insured may obtain a standing referral to a health care specialist.

(2) The procedure established under Subsection (1):

(a) shall provide for a standing referral to a specialist if the insured's primary care provider determines, in consultation with the specialist, that the insured needs continuing care from the specialist;  and

(b) may require the insurer's approval of a treatment plan designed by the specialist, in consultation 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.

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Cite this article: FindLaw.com - Utah Code Title 31A. Insurance Code § 31A-22-628. Standing referral to a specialist - last updated May 05, 2022 | https://codes.findlaw.com/ut/title-31a-insurance-code/ut-code-sect-31a-22-628/

Read this complete Utah Code Title 31A. Insurance Code § 31A-22-628. Standing referral to a specialist on Westlaw

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