§ 22:2439 — Binding nature of external review decision

§2439. Binding nature of external review decision
A. A standard or an expedited external review decision shall be binding on the
health insurance issuer except to the extent the health insurance issuer has other remedies
available under applicable federal or state law.
B. A standard or an expedited external review decision shall be binding on the
covered person except to the extent the covered person has other remedies available under
applicable federal or state law.
C. A covered person or his authorized representative may not file a subsequent
request for a standard or expedited external review involving the same adverse determination
or final adverse determination for which the covered person has already received a standard
or expedited external review decision pursuant to this Part.
D. For any decision by an independent review organization in favor of the covered
person, a health insurance issuer may only subsequently deny coverage of the services that
were the subject of review if it is determined that the covered person was ineligible for
coverage due to nonpayment of premiums or for suspected fraud or material
misrepresentation of fact.

Legislative History

Acts 2013, No. 326, §1, eff. Jan. 1, 2015; Acts 2022, No. 81, §1, eff. Jan. 1, 2023.