Plain English Breakdown
The source material contains conflicting status information: one section states 'Passed Legislature' while another lists 'Last action: In committee'. The summary relies on the text of the bill itself rather than its current procedural status.
New Rules for Health Plan Provider Directories
AB-787 requires health plans and insurers to add a notice at the top of their provider lists advising members on how to get help finding doctors, and sets time limits for responding to those requests.
What This Bill Does
- Requires full-service health care service plans, specialized mental health or dental plans, and similar insurers to place a statement at the top of their printed or online provider directories.
- The statement must advise members to contact the plan if they need help finding an in-network doctor or want to know about out-of-network coverage rights.
- Sets specific rules for how this notice must be written and formatted.
- Requires plans to acknowledge a member's request for assistance within one business day.
- Mandates that plans provide a list of doctors confirmed to accept new patients within two days for urgent requests or five days for non-urgent requests.
Who It Names or Affects
- Full-service health care service plans
- Specialized mental health and dental plans
- Health insurers, including those specializing in mental health or dental coverage
- Enrollees and insured individuals who use these provider directories
Terms To Know
- Provider directory
- A list of doctors and other medical providers that a patient can see under their health plan.
- In-network provider
- A doctor or clinic that has agreed to work with the insurance company at set rates.
- Out-of-network coverage
- Insurance benefits for seeing doctors who do not have a contract with the specific health plan.
Limits and Unknowns
- The official text does not specify an effective date.
- While the bill passed the legislature, it is unclear if executive action (such as signing by the governor) has occurred based on this source alone.
- The specific reason why no state reimbursement is required for local agencies is stated but not explained in detail.