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

Indiana Statutes

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

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

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a waiver described in IC 27-8-5-2.5(e) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1, 2007, and repealed).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.

Free access — add to your briefcase to read the full text and ask questions with AI

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a waiver described in IC 27-8-5-2.5(e) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1, 2007, and repealed).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.

Indiana § 27-8-29-12 (Insurer to establish external grievance procedures) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.