§ 1371.36. — 1371.36. (Added by Stats. 2000, Ch. 827, Sec. 5.)

California § 1371.36.

• Jurisdiction: California
• Code HSC: Health and Safety Code - HSC
• Div. 2.: DIVISION 2. LICENSING PROVISIONS
• Ch. 2.2.: CHAPTER 2.2. Health Care Service Plans
• Art. 5.: ARTICLE 5. Standards

Text

(a)
A health care service plan shall not deny payment of a claim on the basis that the plan, medical group, independent practice association, or other contracting entity did not provide authorization for health care services that were provided in a licensed acute care hospital and that were related to services that were previously authorized, if all of the following conditions are met:
(1)
It was medically necessary to provide the services at the time.
(2)
The services were provided after the plan’s normal business hours.
(3)
The plan does not maintain a system that provides for the availability of a plan representative or an alternative means of contact through an electronic system, including voicemail or electronic mail, whereby the plan can respond to a request for authorization within 30 minutes of the time that a request was made.
(b)
This section shall not apply to investigational or experimental therapies, or other noncovered services.

Legislative History

Added by Stats. 2000, Ch. 827, Sec. 5. Effective January 1, 2001.