Indiana § 27-1-37.5-1.5 "Adverse determination"

Indiana Statutes

§ 27-1-37.5-1.5 — "Adverse determination"

Indiana § 27-1-37.5-1.5

Title 27INSURANCE

Art. 1DEPARTMENT OF INSURANCE

Ch. 37.5Health Care Service Prior Authorization

This text of Indiana § 27-1-37.5-1.5 ("Adverse determination") is published on Counsel Stack Legal Research, covering Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ind. Code § 27-1-37.5-1.5 (2026).

Text

5. As used in this chapter, "adverse determination" means a decision by a utilization review entity to deny, reduce, or terminate benefit coverage of a health care service furnished or proposed to be furnished to a covered individual on the grounds that the health care service:

(1)is not medically necessary, appropriate, effective, or efficient;

(2)is not being provided in or at an appropriate health care setting or level of care; or

(3)is experimental or investigational.

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5. As used in this chapter, "adverse
determination" means a decision by a utilization review entity to deny,
reduce, or terminate benefit coverage of a health care service furnished
or proposed to be furnished to a covered individual on the grounds that
the health care service:
(1) is not medically necessary, appropriate, effective, or efficient;
(2) is not being provided in or at an appropriate health care setting
or level of care; or
(3) is experimental or investigational.