§ 27-13-39-3 — Written explanation of denial of coverage of experimental treatment; review

Indiana § 27-13-39-3

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 13: HEALTH MAINTENANCE ORGANIZATIONS
• Ch. 39: Patient Protection; Experimental Treatments

Text

(a) If a health maintenance organization
denies coverage for a treatment, procedure, drug, or device on the
grounds that the treatment, procedure, drug, or device is experimental,
the health maintenance organization shall provide the enrollee with a
written explanation that includes the following:
(1) The basis for the denial.
(2) The enrollee's right to appeal the health maintenance
organization's decision as provided in IC 27-8-16-8, IC 27-8-17-12, and IC 27-13-10.
(3) The telephone number of:
(A) an individual employed by the health maintenance
organization whom; or
(B) a department of the health maintenance organization that;
the enrollee may contact for assistance in initiating an appeal of
the health maintenance organization's decision.
(b) An enrollee is entitled to a review that takes not more than
seventy-two (72) hours if the enrollee's health situation is life
threatening or is an emergency.

Legislative History

As added by P.L.69-1998, SEC.17.