Indiana § 27-13-10.1-6 Reconsideration of resolution

Indiana Statutes

§ 27-13-10.1-6 — Reconsideration of resolution

Indiana § 27-13-10.1-6

Title 27INSURANCE

Art. 13HEALTH MAINTENANCE ORGANIZATIONS

Ch. 10.1External Review of Grievances

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Bluebook

Ind. Code § 27-13-10.1-6 (2026).

Text

(a)If at any time during an external review performed under this chapter, the enrollee submits information to the health maintenance organization that is relevant to the health maintenance organization's resolution under IC 27-13-10-8 and was not considered by the health maintenance organization under IC 27-13-10:

(1)the health maintenance organization shall reconsider the health maintenance organization's resolution under IC 27-13-10-8; and

(2)the independent review organization shall cease the external review process until the reconsideration under subsection (b) is completed.

(b)A health maintenance organization to which information is submitted under subsection (a) shall reconsider the resolution under IC 27-13-10-8 based on the information and notify the enrollee of the health mai

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(a) If at any time during an external review
performed under this chapter, the enrollee submits information to the
health maintenance organization that is relevant to the health
maintenance organization's resolution under IC 27-13-10-8 and was not
considered by the health maintenance organization under IC 27-13-10:
(1) the health maintenance organization shall reconsider the
health maintenance organization's resolution under IC 27-13-10-8; and
(2) the independent review organization shall cease the external
review process until the reconsideration under subsection (b) is
completed.
(b) A health maintenance organization to which information is
submitted under subsection (a) shall reconsider the resolution under IC 27-13-10-8 based on the information and notify the enrollee of the
health maintenance organization's decision:
(1) within seventy-two (72) hours after the information is
submitted for a reconsideration related to an illness, a disease, a
condition, an injury, or a disability that would seriously jeopardize
the enrollee's:
(A) life or health; or
(B) ability to reach and maintain maximum function; or
(2) within fifteen (15) days after the information is submitted for
a reconsideration not described in subdivision (1).
(c) If the decision reached under subsection (b) is adverse to the
enrollee, the enrollee may request that the independent review
organization resume the external review under this chapter.