Section 376.325

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 2013   

  376.325.  Any willing provider provision — definitions. — 1.  To the extent a health carrier has developed a closed or exclusive provider network as provided in subdivision (19) of section 376.426 through contractual arrangements with selected providers, such health carrier shall accept into such closed or exclusive network any willing licensed physician who agrees to accept a fee schedule, payment, or reimbursement rate that is fifteen percent less than the health carrier's standard prevailing or market fee schedule, payment, or reimbursement rate for such network in the specific geography of the licensed physician's practice.

  2.  This section shall not apply to any licensed physician who does not meet the health carrier's selection standards and credentialing criteria or who has not entered into the health carrier's standard participating provider agreement.

  3.  As used in this section, the term "health carrier" shall have the same meaning ascribed to it in section 376.1350.  The term "physician" shall mean a physician licensed to practice in Missouri under the provisions of chapter 334.  As used in this section, a "closed or exclusive provider network" is a network for a health benefit plan that requires all health care services to be delivered by a participating provider in the health carrier's network, except for emergency services, as defined in section 376.1350, and the services described in subsection 4 of section 376.811.

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(L. 2013 S.B. 262)