Montana Code 50-4-518. Disclosures required of health insurers — limitations
50-4-518. Disclosures required of health insurers — limitations. (1) When requested by an insured or the insured’s agent, a health insurer shall provide a summary of the insured’s coverage for a specific health care service or course of treatment when an actual charge or estimate of charges by a health care provider, outpatient center for surgical services, clinic, or hospital exceeds $500.
Terms Used In Montana Code 50-4-518
- Health care: includes both physical health care and mental health care. See Montana Code 50-4-504
- Health insurer: means any health insurance company, health service corporation, health maintenance organization, insurer providing disability insurance as described in 33-1-207, and to the extent permitted under federal law, any administrator of an insured, self-insured, or publicly funded health care benefit plan offered by public and private entities. See Montana Code 50-4-504
- provider: means a person who is licensed, certified, or otherwise authorized by the laws of this state to provide health care in the ordinary course of business or practice of a profession. See Montana Code 50-4-504
- Writing: includes printing. See Montana Code 1-1-203
(2)The insured or insured’s agent may request that the information required under this section be provided in writing or electronically.
(3)The health insurer shall make a good faith effort to provide accurate information under this section. The health insurer is only required to provide information under this section based upon cost estimates and procedure codes obtained by the insured from the insured’s health care provider.