Montana Code 33-22-1903. Obstetricians or gynecologists as primary care physicians
33-22-1903. Obstetricians or gynecologists as primary care physicians. (1) Each health benefit plan that provides coverage for primary care or obstetrical or gynecological care must allow obstetricians and gynecologists to participate as primary care physicians. The health carrier that provides the health benefit plan shall contract with a sufficient number of obstetricians and gynecologists to ensure that covered persons have access to the options under this section without unreasonable delay if there are obstetricians or gynecologists practicing in the geographic service areas in which the plan operates who are willing to participate in the plan. An obstetrician or gynecologist may not be required to accept primary care physician status if the obstetrician or gynecologist does not wish to be designated as a primary care physician. A health benefit plan must use the same criteria with regard to credentials and other selection criteria for a participating obstetrician or gynecologist as are applied by the health benefit plan with respect to other physicians who are participating in the health benefit plan. An obstetrician or gynecologist wishing to accept designation as a primary care physician must meet the same criteria with regard to credentials and other selection criteria for a participating primary care physician as other physicians who are participating as primary care physicians in the health benefit plan.
Terms Used In Montana Code 33-22-1903
- Contract: A legal written agreement that becomes binding when signed.
- Covered person: means a policyholder, subscriber, certificate holder, enrollee, or other individual who is participating in a health benefit plan. See Montana Code 33-22-1902
- Health benefit plan: means any individual or group plan, policy, certificate, subscriber contract, contract of insurance provided by a managed care plan, preferred provider agreement, or health maintenance organization subscriber contract that is issued, delivered, issued for delivery, or renewed in this state by a health carrier that pays for, purchases, or furnishes health care services to covered persons who receive health care services in this state. See Montana Code 33-22-1902
- Health carrier: means a disability insurer, health care insurer, health maintenance organization, accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, health service corporation, health care service plan, preferred provider organization or arrangement, multiple employer welfare arrangement, or any other person, firm, corporation, joint venture, or similar business entity. See Montana Code 33-22-1902
- Obstetrician or gynecologist: means a physician who is board-eligible or board-certified by the American board of obstetrics and gynecology. See Montana Code 33-22-1902
- Participating obstetrician or gynecologist: means an obstetrician or gynecologist who is employed by or under contract with a health benefit plan. See Montana Code 33-22-1902
- Person: includes a corporation or other entity as well as a natural person. See Montana Code 1-1-201
- Primary care physician: means a physician who has the responsibility for providing initial and primary care to patients, for maintaining the continuity of patient care, and for initiating referrals for specialist care. See Montana Code 33-22-1902
(2)Each health benefit plan must allow a covered person to select any participating obstetrician or gynecologist of the covered person‘s choice as the covered person’s primary care physician.