☰ Revisor of Missouri

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 1992, 2 histories, see footnote (history) bottom

  376.427.  Assignment of benefits made by insured to provider — payment, how made — exceptions — all claims to be paid, when. — 1.  As used in this section, the following terms mean:

  (1)  "Health care services", medical, surgical, dental, podiatric, pharmaceutical, chiropractic, licensed ambulance service, and optometric services;

  (2)  "Insured", any person entitled to benefits under a contract of accident and sickness insurance, or medical-payment insurance issued as a supplement to liability insurance but not including any other coverages contained in a liability or a workers' compensation policy, issued by an insurer;

  (3)  "Insurer", any person, reciprocal exchange, interinsurer, fraternal benefit society, health services corporation, self-insured group arrangement to the extent not prohibited by federal law, or any other legal entity engaged in the business of insurance;

  (4)  "Provider", a physician, hospital, dentist, podiatrist, chiropractor, pharmacy, licensed ambulance service, or optometrist, licensed by this state.

  2.  Upon receipt of an assignment of benefits made by the insured to a provider, the insurer shall issue the instrument of payment for a claim for payment for health care services in the name of the provider.  All claims shall be paid within thirty days of the receipt by the insurer of all documents reasonably needed to determine the claim.

  3.  Nothing in this section shall preclude an insurer from voluntarily issuing an instrument of payment in the single name of the provider.

  4.  This section shall not require any insurer, health services corporation, health maintenance corporation or preferred provider organization which directly contracts with certain members of a class of providers for the delivery of health care services to issue payment as provided pursuant to this section to those members of the class which do not have a contract with the insurer.

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(L. 1990 H.B. 1739 § 14, A.L. 1992 S.B. 698)


---- end of effective   28 Aug 1992 ----

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