S-2125.1                   _______________________________________________

                                            SUBSTITUTE SENATE BILL 5459

                              _______________________________________________

State of Washington                              53rd Legislature                             1993 Regular Session

By Senate Committee on Health & Human Services (originally sponsored by Senators West, Wojahn, Sheldon and Sellar)

Read first time 03/03/93.

Regulating prescription claims for insurance coverage that were initially approved over the telephone or by other means.

          AN ACT Relating to prescription claims insurance coverage; adding a new section to chapter 48.20 RCW; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; and creating a new section.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1.  The legislature finds that many health care insurance entities are initially approving claims as eligible under an identified program, over the telephone, but denying those same claims when they are submitted for payment.  The legislature finds this to be an untenable situation for the providers.

NEW SECTION. Sec. 2.  A new section is added to chapter 48.20 RCW to read as follows:

          Disability insurance companies or their designated representative who have first approved, by any means, an individual prescription claim as eligible may not reject that claim at some later date.  Pharmacists or drug dispensing outlets who obtain preapproval of claims shall keep a written  record of the preapproval that consists of identification by name and telephone number of the person who approved the claim.

NEW SECTION. Sec. 3.  A new section is added to chapter 48.21 RCW to read as follows:

          Group disability insurance companies or their designated representative who have first approved, by any means, an individual prescription claim as eligible may not reject that claim at some later date.  Pharmacists or drug dispensing outlets who obtain preapproval of claims shall keep a written  record of the preapproval that consists of identification by name and telephone number of the person who approved the claim.

NEW SECTION. Sec. 4.  A new section is added to chapter 48.44 RCW to read as follows:

          Health care service contractors or their designated representative who have first approved, by any means, an individual prescription claim as eligible may not reject that claim at some later date.  Pharmacists or drug dispensing outlets who obtain preapproval of claims shall keep a written  record of the preapproval that consists of identification by name and telephone number of the person who approved the claim.

NEW SECTION. Sec. 5.  A new section is added to chapter 48.46 RCW to read as follows:

          Health maintenance organizations or their designated representative who have first approved, by any means, an individual prescription claim as eligible may not reject that claim at some later date.  Pharmacists or drug dispensing outlets who obtain preapproval of claims shall keep a written  record of the preapproval that consists of identification by name and telephone number of the person who approved the claim.

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