Section 1383.1 Of Article 6. Operation And Renewal Requirements And Procedures From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 6.
1383.1
. (a) On or before July 1, 1997, every health care service
plan shall file with the department a written policy, which is not
subject to approval or disapproval by the department, describing the
manner in which the plan determines if a second medical opinion is
medically necessary and appropriate. Notice of the policy and
information regarding the manner in which an enrollee may receive a
second medical opinion shall be provided to all enrollees in the plan'
s evidence of coverage. The written policy shall describe the manner
in which requests for a second medical opinion are reviewed by the
plan.
(b) This section shall not apply to any health care service plan
contract authorized under Article 5.6 (commencing with Section
1374.60).
(c) Nothing in this section shall require a health care service
plan to cover services or provide benefits that are not otherwise
covered under the terms and conditions of the plan contract, nor to
provide services through providers who are not under contract with
the plan.