§ 27-8-28-6 — "Grievance"

As used in this chapter, "grievance" means any
dissatisfaction expressed by or on behalf of a covered individual
regarding:
(1) a determination that a service or proposed service is not
appropriate or medically necessary;
(2) a determination that a service or proposed service is
experimental or investigational;
(3) the availability of participating providers;
(4) the handling or payment of claims for health care services;
(5) matters pertaining to the contractual relationship between:
(A) a covered individual and an insurer; or
(B) a group policyholder and an insurer;
(6) an insurer's decision to rescind an accident and sickness
insurance policy; or
(7) a determination concerning a prior authorization request under
IC 27-1-37.5;
and for which the covered individual has a reasonable expectation that
action will be taken to resolve or reconsider the matter that is the
subject of dissatisfaction.

Legislative History

As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.1-2002, SEC.114; P.L.160-2011, SEC.22; P.L.77-2018, SEC.3.