The Iowa House passed legislation on Feb. 25 that would ban health insurers from denying coverage for a service solely because the referring primary care provider is out of network.
Under the legislation, insurers would also be barred from imposing cost-sharing, including deductibles, coinsurance, or copays, on the referred covered benefit that exceeds what the member would have paid had the referral come from an in-network provider.
The bill defines primary care provider broadly to include physicians practicing as family or general practitioners, pediatricians, internists, obstetricians, or gynecologists, as well as advanced registered nurse practitioners and physician assistants. The legislation would apply specifically to individuals operating under a direct primary care agreement.
Self-funded plans would not be subject to the new requirement if the law is enacted. The law would apply to referrals made on or after July 1, and the bill now moves to the Iowa Senate for consideration.
