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HSB 506

A bill for an act relating to insurance coverage for health care services provided pursuant to a referral by an out-of-network primary care provider.

2025-2026 Regular Session

Requires insurers to cover specialist services referred by out-of-network primary care doctors, preventing coverage denials based solely on provider network status.

Subcommittee: Harris, Baeth and Weldon. H.J. 01/12.
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Bill Summary · HSB 506

Legislative bill overview

HSB 506 requires health insurance plans to cover health care services that are referred by out-of-network primary care providers, treating such referrals similarly to in-network referrals for coverage purposes. The bill addresses situations where patients see primary care doctors outside their insurance network and receive referrals to specialists, clarifying that insurers must cover the referred services.

Why is this important

This bill affects patient access and costs when using out-of-network primary care. Without this protection, patients could face surprise coverage gaps—their primary doctor recommends a specialist, but the insurer denies coverage because that specialist is out-of-network, leaving patients responsible for full costs. The provision directly impacts healthcare affordability and continuity of care for Iowans, particularly in rural areas with limited in-network provider availability.

Potential points of contention

  • Insurance industry costs: Insurers may argue this expands their coverage obligations and increases premiums, as they lose control over which providers deliver referred care
  • Network adequacy questions: The bill doesn't address whether insurers must maintain adequate in-network primary care providers, potentially shifting blame for network gaps to patients' choices
  • Scope ambiguity: The bill's language on what constitutes a valid "referral" and which services qualify may create disputes between insurers and providers over coverage obligations

Compiled from official sources — confirm details with the bill’s official record.

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