Bill > SB83

This bill mandates comprehensive coverage for breast reconstruction surgeries in Arkansas, effective January 1, 2026, requiring health benefit plans to cover all types and modalities of breast reconstruction as determined by a healthcare professional in consultation with the patient. The legislation broadly defines breast reconstruction surgery to include multiple procedures such as augmentation, reduction, implant-based and tissue-based reconstructions, and associated treatments like chest wall reconstruction and prosthesis replacement. The bill requires prior authorization for these surgeries and establishes that if an insurer lacks an in-network provider for a recommended procedure, they must automatically approve a single case agreement. Furthermore, the bill sets reimbursement rates for out-of-network providers at the lesser of the provider's billed charges or the 80th percentile of similar charges in the geographic area, with significant financial penalties for insurers who fail to comply. The legislation also prohibits insurers from denying coverage or eligibility solely to avoid these requirements and explicitly states that the provisions cannot be waived by contract, ensuring robust protection for patients seeking breast reconstruction services.

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https://arkleg.state.ar.us/Bills/Detail?id=sb83&ddBienniumSession=2025%2F2025R