376.1253. Second opinion, right of newly diagnosed cancer patients, attending physician to inform--insurance coverage for such second opinions required, when.
Second opinion, right of newly diagnosed cancer patients, attendingphysician to inform--insurance coverage for such second opinionsrequired, when.
376.1253. 1. Each physician attending any patient with a newlydiagnosed cancer shall inform the patient that the patient has the right to areferral for a second opinion by an appropriate board-certified specialistprior to any treatment. If no specialist in that specific cancer diagnosisarea is in the provider network, a referral shall be made to a nonnetworkspecialist in accordance with this section.
2. Each health carrier or health benefit plan, as defined in section376.1350, that offers or issues health benefit plans which are delivered,issued for delivery, continued or renewed in this state on or after January 1,2003, shall provide coverage for a second opinion rendered by a specialist inthat specific cancer diagnosis area when a patient with a newly diagnosedcancer is referred to such specialist by his or her attending physician. Suchcoverage shall be subject to the same deductible and coinsurance conditionsapplied to other specialist referrals and all other terms and conditionsapplicable to other benefits, including the prior authorization and/orreferral authorization requirements as specified in the applicable healthinsurance policy.
3. The provisions of this section shall not apply to a supplementalinsurance policy, including a life care contract, accident-only policy,specified disease policy, hospital policy providing a fixed daily benefitonly, Medicare supplement policy, long-term care policy, short-term majormedical policies of six months' or less duration, or any other supplementalpolicy as determined by the director of the department of insurance, financialinstitutions and professional registration.
(L. 2002 S.B. 1026)