§ 27-8-29-12 — Insurer to establish external grievance procedures

Indiana § 27-8-29-12

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 29: External Review of Grievances

Text

An insurer shall establish and maintain an
external grievance procedure for the resolution of external grievances
regarding the following:
(1) The following determinations made by the insurer or an agent
of the insurer regarding a service proposed by the treating health
care provider:
(A) An adverse determination of appropriateness.
(B) An adverse determination of medical necessity.
(C) A determination that a proposed service is experimental or
investigational.
(D) A denial of coverage based on a waiver described in IC 27-8-5-2.5(e) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1, 2007, and repealed).
(2) The insurer's decision to rescind an accident and sickness
insurance policy.

Legislative History

As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.211-2003, SEC.7; P.L.3-2008, SEC.216; P.L.160-2011, SEC.23.