IN HB1373

Requires state employee health plans, accident and sickness insurance policies, and HMO contracts to cover all breast reconstruction surgery modalities, types, and techniques following mastectomy, trauma, congenital conditions, or prophylactic procedures, effective January 1, 2027

Mandates insurers maintain adequate breast reconstruction surgeon networks with at least one physician per 20,000 female covered individuals for each reconstruction modality and type

Prohibits utilization review entities from denying pre-authorized breast reconstruction surgery claims unless they provide formal declaration of compelling evidence of provider fraud

Requires automatic single-case agreements for out-of-network providers when networks are inadequate, with reimbursement at the lesser of billed charges or the 80th percentile of regional charges; imposes penalties of 3x the underpayment difference for non-compliant reimbursements

Prohibits insurers from implementing referral systems that cause undue delays or require unreasonable travel distances for breast reconstruction, and makes all coverage requirements non-waivable by contract