58-17-54 Reimbursement provisions applicable to all healing arts licensees--Self-insurance plans fo...
Reimbursement provisions applicable to all healing arts licensees--Self-insurance
plans for public employees--Restrictions on policy limitations.
Notwithstanding any provision of any
policy of insurance subject to the general provisions of this title, if a policy or contract provides for
reimbursement for any service which may be legally performed by a person licensed in this state for
the practice of medicine, surgery, anesthesia by a certified registered nurse anesthetist licensed under
chapter 36-9, psychology, dentistry, osteopathy, social work by an independent social worker
licensed under § 36-26-17, optometry, chiropractic, or podiatry, the reimbursement under that policy
or contract may not be denied if the service is rendered by a person so licensed. The provisions of
this section apply to all practitioners licensed pursuant to chapters 36-4A and 36-9A after July 1,
1980, and to any plan of self-insurance for public employees. Reimbursement may be denied to a
policyholder treating himself or any member of his family residing in his household. However,
reimbursement for durable medical equipment, pharmaceuticals, and prosthetic devices may not be
denied if within policy coverages.
No policy, certificate, or contract may exclude or limit reimbursement for any lawful diagnostic
or treatment service by a licensee under chapter 36-5 if the exclusion or limitation is based wholly
or in part on any requirement that the service be performed in a place of service not normally used
by the licensee.
A policy, certificate, or contract may only limit or make optional the reimbursement for any
lawful diagnostic or treatment service by a licensee under chapters 36-4 and 36-5 if the limitation
is based on a rational basis which is not solely related to the license under, or practices authorized
by, chapter 36-5 or is not dependent upon a method of classification, categorization or description
based directly or indirectly upon differences in terminology used by different licensees in describing
human ailments or in the diagnosis or treatment of human ailments.
This section does not require reimbursement for any method or service not necessary, not
reasonable or not generally accepted by the peers of the particular licensed health care provider.
Source: SL 1970, ch 273; SL 1980, ch 355, § 2; SL 1981, ch 24, § 6; SL 1982, ch 363, § 2; SL
1986, ch 419, § 1; SL 1988, ch 402; SL 1989, ch 427; SL 1993, ch 360.