Kansas Statutes 40-4603. Same; emergency services, prohibitions on health care plan; prior authorization after condition stabilized; post evaluation or post stabilization services
Terms Used In Kansas Statutes 40-4603
- Emergency medical condition: means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical attention, where failure to provide medical attention would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy. See Kansas Statutes 40-4602
- Emergency services: means ambulance services and health care items and services furnished or required to evaluate and treat an emergency medical condition, as directed or ordered by a physician. See Kansas Statutes 40-4602
- Fraud: Intentional deception resulting in injury to another.
- Health benefit plan: means any hospital or medical expense policy, health, hospital or medical service corporation contract, a plan provided by a municipal group-funded pool, a policy or agreement entered into by a health insurer or a health maintenance organization contract offered by an employer or any certificate issued under any such policies, contracts or plans. See Kansas Statutes 40-4602
- Health insurer: means any insurance company, nonprofit medical and hospital service corporation, municipal group-funded pool, fraternal benefit society, health maintenance organization, or any other entity which offers a health benefit plan subject to the Kansas Statutes Annotated. See Kansas Statutes 40-4602
- Insured: means a person who is covered by a health benefit plan. See Kansas Statutes 40-4602
- Participating provider: means a provider who, under a contract with the health insurer or with its contractor or subcontractor, has agreed to provide one or more health care services to insureds with an expectation of receiving payment, other than coinsurance, copayments or deductibles, directly or indirectly from the health insurer. See Kansas Statutes 40-4602
- Provider: means a physician, hospital or other person which is licensed, accredited or certified to perform specified health care services. See Kansas Statutes 40-4602
(a) A health benefit plan shall not deny coverage for emergency services if the symptoms presented by an insured and recorded by the attending provider indicate that an emergency medical condition exists, or for emergency services necessary to provide an insured with a medical examination and stabilizing treatment, regardless of whether prior authorization was obtained to provide those services.
(b) If a participating provider or other authorized representative of a health insurer authorizes emergency services, the health insurer shall not subsequently rescind or modify that authorization after the provider renders the authorized care in good faith and pursuant to the authorization except for:
(1) Payments made as a result of misrepresentation, fraud, omission or clerical error; and
(2) copayment, coinsurance or deductible amounts that are the responsibility of the insured.
(c) Once an insured is stabilized pursuant to subsection (a), a health benefit plan may require as a condition of further coverage that a hospital emergency facility shall promptly contact the health insurer for prior authorization for continuing treatment, specialty consultations, transfer arrangements or other medically necessary and appropriate care for an insured.
(d) Coverage of emergency services shall be subject to applicable copayments, coinsurance and deductibles.
(e) For required post evaluation or post stabilization services immediately following treatment of an emergency medical condition, a health insurer shall provide access to an authorized representative 24 hours a day, seven days a week.