Louisiana § 22:1060.4 Adverse determination

Louisiana Statutes

§ 22:1060.4 — Adverse determination

Louisiana § 22:1060.4

Title 22Insurance

This text of Louisiana § 22:1060.4 (Adverse determination) is published on Counsel Stack Legal Research, covering Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

La. Stat. Ann. § 22:1060.4 (2026).

Text

§1060.4. Adverse determination A. The refusal of a health insurance issuer to provide benefits to an enrollee for a prescription drug is an adverse determination for purposes of the Internal Claims and Appeals Process and External Review Act, R.S. 22:2391 et seq., if each of the following conditions is met:

(1)The drug is not included in a drug formulary used by the health benefit plan.

(2)The enrollee's physician or other authorized prescriber has determined the drug is medically necessary. B. The enrollee may appeal the adverse determination pursuant to the Internal Claims and Appeals Process and External Review Act, R.S. 22:2391 et seq.

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

§1060.4. Adverse determination
A. The refusal of a health insurance issuer to provide benefits to an enrollee for a
prescription drug is an adverse determination for purposes of the Internal Claims and
Appeals Process and External Review Act, R.S. 22:2391 et seq., if each of the following
conditions is met:
(1) The drug is not included in a drug formulary used by the health benefit plan.
(2) The enrollee's physician or other authorized prescriber has determined the drug
is medically necessary.
B. The enrollee may appeal the adverse determination pursuant to the Internal Claims
and Appeals Process and External Review Act, R.S. 22:2391 et seq.