Provider directory disclosures.

Plain English Breakdown

The official source does not specify that violating the provisions would be a criminal offense, but rather implies it through existing law references.

Health Care Provider Directory Disclosures

The bill requires health care plans and insurers to include specific information in their provider directories, advising patients on how to find in-network providers and providing a timeline for responding to requests.

What This Bill Does

• Requires full-service health care plans, specialized mental health or dental plans, health insurers, and specialized mental health or dental insurers to add a statement at the top of their provider directory advising enrollees or insureds to contact the plan or insurer for assistance in finding an in-network provider.
• Specifies that the statement must also explain patient rights regarding out-of-network coverage.
• Requires these organizations to acknowledge requests within one business day and provide a list of in-network providers confirmed to be accepting new patients within two days if deemed urgent by the enrollee or insured, and five days for non-urgent requests.

Who It Names or Affects

• Health care service plans
• Specialized mental health or dental plans
• Health insurers
• Patients seeking in-network providers

Terms To Know

Provider directory

A list of doctors, hospitals, and other healthcare providers who are part of a patient's insurance plan.

In-network provider

A doctor or hospital that is part of your health insurance plan and typically offers lower costs for services.

Limits and Unknowns

• The bill does not specify the exact format of the statement to be included in the provider directory.
• It is unclear how this bill will affect patients who do not have access to online directories or technology.

Official Summary Text

AB 787, as amended, Papan.
Provider directory disclosures.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires specified health care service plans and health insurers to publish and maintain a provider directory or directories with information on contracting providers that deliver health care services to enrollees or insureds, and requires a health care service plan or health insurer to regularly update its printed and online provider directory or directories, as specified. Existing law requires provider directories to include specified information and disclosures.
This bill would require a full service health care
service plan, specialized mental health
or dental
plan, health insurer, or specialized mental health
or dental
insurer to include in its provider directory or directories a statement
at the top of the directory
advising an enrollee or insured to contact the plan or insurer for assistance
in
finding an in-network
provider.
provider and for an explanation of their rights regarding out-of-network coverage, and would specify the format of the statement.
The bill would require the plan or insurer to
respond
acknowledge the request
within one business day if contacted for that assistance, and to provide a list of in-network providers confirmed to be accepting new patients within 2 business
days.
days for a request deemed urgent by the enrollee or insured and 5 business days for a request deemed nonurgent by an enrollee or insured.
Because a violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local
program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

Current Bill Text

Download Bill PDF