Freedom to Purchase Medical Services Act Exposed

The Freedom to Purchase Medical Services Act was adopted by ALEC's Health and Human Services Task Force at the 2013 Annual Meeting, approved by the Board of Directors September 29, 2013. (Accessed January 30, 2017)

ALEC Bill Text

Summary

This bill protects a patient’s right to purchase health care services outside of the patient’s insurance or Medicaid plan. Patients may pay out-of-pocket for such services and health care professionals may accept those out-of-pocket payments. Further, this bill stipulates that the provision of medical services purchased and provided under the provisions of the bill shall not be deemed an offer of insurance nor be regulated by the insurance laws of the state.

Model Policy Model Policy

Section 1 Title. This Act shall be known as the “Freedom to Purchase Medical Services Act.”

Section 2 Protection of Patient’s Right to Seek Care Outside of Insurance Plan.

Nothing in State law shall be construed as prohibiting a patient or legal representative from seeking care outside the patient’s insurance plan, or outside the Medicaid program, and paying for such care.

Section 3 Protection of Medical Professional’s Right to Accept Out-of-Pocket Payment.

Nothing in State law shall be construed as prohibiting a physician, other medical professional, or medical facility from accepting payment for out-of-network services or for private services provided to a Medicaid beneficiary.

Section 4 Protection of Benefits.

A patient or legal representative shall not forfeit insurance benefits or Medicaid benefits because of purchasing medical services outside the system.

Section 5 Services Not Deemed Insurance.

The offer and provision of medical services purchased and provided under this Act shall not be deemed an offer of insurance nor regulated by the insurance laws of this State.

Section 6 Required Disclosures.

Providers must disclose the text of the Enrollee Hold Harmless Clause, or its equivalent, in insurance or managed-care provider contracts to patients or legal representatives if authorization for services or claims are denied, together with a plain-English explanation of its meaning.

Section 7 {Severability clause.}

Section 8 {Repealer clause.}

Section 9 {Effective date.}