Maine § 24-A §2847-D Penalty for noncompliance with utilization review programs

Maine Statutes

§ 24-A §2847-D — Penalty for noncompliance with utilization review programs

Maine·Title 24-A MAINE INSURANCE CODE·Ch. 35 GROUP AND BLANKET HEALTH INSURANCE

A policy or certificate issued or renewed after April 8, 1994 may not contain a provision that permits, upon retroactive review and confirmation of medical necessity, the imposition of a penalty of more than $500 for failure to provide notification under a utilization review program. This section does not limit the right of insurers to deny a claim when appropriate prospective or retroactive review concludes that services or treatment rendered were not medically necessary.

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A policy or certificate issued or renewed after April 8, 1994 may not contain a provision that permits, upon retroactive review and confirmation of medical necessity, the imposition of a penalty of more than $500 for failure to provide notification under a utilization review program. This section does not limit the right of insurers to deny a claim when appropriate prospective or retroactive review concludes that services or treatment rendered were not medically necessary.

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