Radiology benefits managers; decision to deny physician's order for diagnostic radiology test. (HB398)

Introduced By

Del. Patrick Hope (D-Arlington)

Description

Radiology benefits managers.  Requires that any decision by a radiology benefits manager to deny a treating physician's order or recommendation for a diagnostic radiology test be made by a physician. An authorization to perform a diagnostic radiology test given by a health carrier or by a radiology benefits manager shall be conclusive to satisfy any requirement of medical necessity in a health benefit plan or a health carrier's plan, policy, or schedule of benefits. A managed care health insurance utilization review entity's utilization review plan is required to include a provision designed to ensure that adverse determinations by a radiology benefits manager are made by a licensed physician. Any person who countermands the treatment order or recommendation of a treating physician for a diagnostic radiology test by any means or manner that is intended to influence the patient to refuse a recommended diagnostic radiology test or to elect to receive a different service than the diagnostic radiology test ordered or recommended by the treating physician shall be deemed to be practicing medicine. Read the Bill »

Outcome

History