Prior authorization required for breast reconstruction surgery — Single case agreements

Ark. Code Ann. § 23-79-3103 — under Insurance Policies Generally.

Ark. Code Ann. § 23-79-3103

(a) A healthcare insurer shall require prior authorization for breast reconstruction surgery.

(b) If a healthcare insurer does not have a participating provider who provides a breast reconstruction surgery that has been determined as the best course of treatment by a healthcare professional and is consistent with prevailing medical standards and in consultation with the patient, then the healthcare insurer that provides a prior authorization or predetermination of the healthcare service shall automatically approve a single case agreement at the same rate as specified under § 23-79-3104(a).