Indiana § 27-13-10.1-1 External grievance procedure established

Indiana Statutes

§ 27-13-10.1-1 — External grievance procedure established

Indiana § 27-13-10.1-1

Title 27INSURANCE

Art. 13HEALTH MAINTENANCE ORGANIZATIONS

Ch. 10.1External Review of Grievances

This text of Indiana § 27-13-10.1-1 (External grievance procedure established) 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 § 27-13-10.1-1 (2026).

Text

A health maintenance organization shall establish and maintain an external grievance procedure for the resolution of grievances regarding the following:

(1)The following determinations made by the health maintenance organization or an agent of the health maintenance organization regarding a service proposed by the treating physician:

(A)An adverse utilization review determination (as defined in IC 27-8-17-8).

(B)An adverse determination of medical necessity.

(C)A determination that a proposed service is experimental or investigational.

(2)The health maintenance organization's decision to rescind an individual contract or a group contract.

Free access — add to your briefcase to read the full text and ask questions with AI

A health maintenance organization shall
establish and maintain an external grievance procedure for the
resolution of grievances regarding the following:
(1) The following determinations made by the health maintenance
organization or an agent of the health maintenance organization
regarding a service proposed by the treating physician:
(A) An adverse utilization review determination (as defined in
IC 27-8-17-8).
(B) An adverse determination of medical necessity.
(C) A determination that a proposed service is experimental or
investigational.
(2) The health maintenance organization's decision to rescind an
individual contract or a group contract.