| (OB-GYN) without first obtaining
a referral from your PCP. (Name of HMO) has opted not to limit your
selection of an OB-GYN to your PCP's network. You are not required
to select an OB-GYN. You may elect to receive your OB-GYN services
from your PCP."
(g) An HMO must clearly identify limited provider networks
within its service area by providing a separate listing of its limited
provider networks and an alphabetical listing of all the physicians
and providers, including specialists, available in each limited provider
network. An HMO must include an index of the alphabetical listing
of all contracted physicians and providers, including behavioral health
providers and substance abuse treatment providers, if applicable,
within the HMO's service area, and must indicate the limited provider
network(s) to which the physician or provider belongs and the page
number where the physician or provider's name can be found.
(h) An HMO must provide notice to enrollees informing
them to contact the HMO on receipt of a bill for covered services
from any physician or provider, including a facility-based physician
or other health care practitioner. The notice must inform enrollees
of the method(s) for contacting the HMO for this purpose.
(i) If an HMO or limited provider network provides
for an enrollee's care by a physician other than the enrollee's primary
care physician while the enrollee is in an inpatient facility (for
example, a hospital or skilled nursing facility), the plan description
must disclose that on admission to the inpatient facility, a physician
other than the primary care physician may direct and oversee the enrollee's
care.
(j) An HMO that maintains a website must list the information
on its website as required by subsections (b) - (g) of this section
and Insurance Code §843.2015 (concerning Information Available
Through Internet Site) and §1456.003 (concerning Required Disclosure:
Health Benefit Plan). The information must be easily accessible from
the home page of the HMO's website.
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