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

Indiana Statutes

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

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

(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 ta

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(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.

Indiana § 27-13-39-3 (Written explanation of denial of coverage of experimental treatment; review) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.