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

California Statutes

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

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

(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

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(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.

California § 1371.36. (1371.36. (Added by Stats. 2000, Ch. 827, Sec. 5.)) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.