HCS/SB 1103 - This act provides that no licensed health care professional shall charge, bill, or solicit payment for anatomic pathology services, unless the services are rendered personally by the health care professional or under the health care professional's direct supervision. No patient, insurer, third-party payor, hospital, public health clinic, or nonprofit health clinic shall be required to reimburse any licensed health care professional for charges or claims submitted in violation of this act. Nothing in this act will prohibit the billing of a referring laboratory for services when samples must be sent to another specialist. The licenses of health care professionals violating the provisions of this act may be subject to disciplinary action. This provision (section 191.890) is similar to one contained in SB 1076 and HB 1627 (2006). This act modifies what a health insurer must provide when it issues evidence of insurance coverage. The act provides that the evidence of coverage must contain a summary of coinsurance or other cost sharing features the policy may entail. The purported effect of this change is to allow HMOs to issue high-deductible health insurance policies.
The act provide that the rates of payment included in a contract between a HMO and a provider entered into prior to August 28, 2006, shall not apply to enrollees who purchase coverage from the HMO effective on or after August 28, 2006, if that coverage has an enrollee deductible or coninsurance obligation that is higher than was authorized by law prior to August 28, 2006.
STEPHEN WITTE