Purpose

Prohibits the denial of reimbursement for services rendered by physical therapists if the insurance carrier provides benefits for such services.

Background

Current state law prohibits denial of insurance contract benefits to chiropractors, psychologists, nurses, optometrists, psychiatrists, drug abuse services and alcoholism services if an insurance contract provides for or offers reimbursement for any service that is within scope of the practitioner or service.

This measure includes licensed physical therapists to the list of practitioners and services that are ensured reimbursement by insurance carriers. The measure prohibits insurers from denying a claim for covered physical therapy services obtained out-of-network solely on the basis that a physician did not refer the insured to a physical therapist.

Based on the concerns of the Department of Administration regarding the insured person’s ability to seek any physical therapist and the costs associated with such services and how the content of the striker amendment considers those concerns, there appears to be no fiscal impact to the cost of workers compensation payouts or health insurance for state employees related to this bill. A fiscal note has been requested and is forthcoming.

Provisions

1. Prohibits an insurer from denying a claim for covered physical therapy services obtained out-of-network solely on the basis that a physician did not refer the insured to the physical therapist or prescribe specific physical therapy services.

2. Authorizes an insurer, as a condition of coverage of physical therapy services, to impose coinsurance, copayments, deductibles, dollar caps and limitations on the number of visits, provider network restrictions or other cost containment measures.

3. Provides for an effective date that applies to contracts, policies and evidences of coverage issued or renewed on or after January 1, 2003.

Amendments Adopted by Committee

· The strike everything amendment was adopted.

Senate Action

BI 3/14/02 DPA 5-0-1-0

TM/jas