Colorado Legislative Council Staff

NO FISCAL IMPACT

TITLE:            CONCERNING TREATMENT OF INSUREDS BY HEALTH CARE PROVIDERS, AND, IN CONNECTION THEREWITH, ALLOWING SPECIALISTS TO HAVE A STANDING REFERRAL FOR TREATMENT OF AN INSURED WITH A CHRONIC, DISABLING, OR LIFE THREATENING CONDITION AND REQUIRING PROVIDERS TO DISCLOSE THAT THE INSURED MAY SEEK A SECOND OPINION AFTER BENEFITS HAVE BEEN DENIED.

Summary of Assessment

            This bill requires an insurance carrier's contract with a participating provider to include a provision that participating providers inform a covered person that a second opinion for any diagnosis, procedure, or treatment for any condition is with the benefits provided. The bill also requires health insurance carriers providing coverage through managed care plans to allow for a standing referral to an appropriate specialist by a primary care provider for an insured with a chronic, disabling, or life threatening condition. The bill would become effective upon signature of the Governor.

            The bill will require the Division of Insurance, Department of Regulatory Agencies, to promulgate a rule regarding requests for second opinions for medically appropriate treatment. This will have a minimal impact on the workload of the division. This increase in workload could be absorbed by current staff, but may require re-prioritizing existing workload. The bill will not affect any other state agency, or unit of local government. Therefore, this bill is assessed as having no fiscal impact.

Departments Contacted

            Regulatory Agencies