Arizona § 20-1376 - Prohibiting denial of certain contract benefits

§ 20-1376. Prohibiting denial of certain contract benefits

A. Notwithstanding any provision of any disability insurance contract, benefits shall not be denied under the contract for any medical or surgical service performed by a holder of a license issued pursuant to title 32, chapter 7 or 11, or a registered nurse practitioner who is licensed pursuant to title 32, chapter 15, if the service performed is within the lawful scope of such person's license, and if the service is surgical, such person is a member of the staff of an accredited hospital, and if such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to title 32, chapter 13.

B. If any disability insurance contract provides for or offers eye care services, the subscriber shall have freedom of choice to select either an optometrist or a physician and surgeon skilled in diseases of the eye to provide the examination, care, or treatment for which the subscriber is eligible and that falls within the scope of practice of the optometrist or physician and surgeon. Unless such disability insurance contract otherwise provides, there shall be no reimbursement for ophthalmic materials, lenses, spectacles, eyeglasses or appurtenances to these materials or items.

C. If any individual disability insurance contract is written to provide coverage for psychiatric, drug abuse or alcoholism services, reimbursement for such services shall be made in accordance with the terms of the contract without regard to whether the covered services are rendered in a psychiatric special hospital or general hospital. Reimbursement for the cost of the service may be made directly to the person licensed or certified pursuant to title 32, chapter 13 or 19.1 or to the subscriber if the cost of the service has not been reimbursed to another provider or health care institution.