(a) coverage provisions and exclusions; (b) prior authorization or other review requirements; (c) financial arrangements that would limit the services offered, restrict referral options, and establish incentives not to deliver certain services; (d) plan limitations and the impact of any limitations upon an enrollee; and (e) enrollee satisfaction statistics. (2) Patients have a choice of physicians and different types of health plans (3) Patients have the right to change physicians. (4) Patients can submit an appeal on cases where they object to medical decisions made by third party payers regarding their health care. (5) Patients who choose a plan that restricts access to physicians may purchase a point of service option to see any physician outside the plan. (6) Patient or physician requests for prior authorization of a service must be answered within two business days, with personnel available for same day responses regarding questions of medical necessity. The LSMS strongly supports the utilization of Health Savings Accounts (HSAs) as one option in a pluralistic system for patient health care coverage. 121.13 Eligibility, Benefits & Coverage - Commercial Insurance; Pre-existing Conditions REAFFIRMED The LSMS opposes the inclusion of any pre-existing condition clause in a health insurance contract as these clauses generally prevent the acquisition of affordable health care insurance. 121.14 Eligibility, Benefits & Coverage – Commercial Insurance; Lifetime Cap on Benefits REAFFIRMED The LSMS opposes the inclusion of any lifetime cap on benefits in any health insurance contract. 121.15 Eligibility, Benefits & Coverage - Commercial Insurance; Preventative Care REAFFIRMED The LSMS supports requiring all third-party payers to include as a benefit of the health insurance coverage for appropriate preventive care based on evidence-based guidelines developed by nationally recognized medical specialty societies for patients at various stages of life. 121.12 Eligibility, Benefits & Coverage - Health Savings Accounts REAFFIRMED
121.16 Eligibility, Benefits & Coverage - Commercial Insurance; Prompt Pay REAFFIRMED
The LSMS supports requiring commercial health insurance issuers to pay physicians in a timely manner and will continue to inform its members of the law and rules regarding prompt pay in its publications and through its website.
122.03 Health Care Quality Initiatives - Health Care Quality Guidelines REAFFIRMED
The LSMS opposes all government and insurance efforts to take control of quality assurance programs and supports all appropriate avenues to ensure that LSMS
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