§ 44-1317 — Health carrier; disclosure; format; contents

(1)(a)
Each health carrier shall include a description of the external review procedures
in or attached to the policy, certificate, membership booklet, outline of
coverage, or other evidence of coverage it provides to covered persons.
(b) The disclosure required
by subdivision (1)(a) of this section shall be in a format prescribed by the
director.
(2)
The description required under subsection (1) of this section shall include
a statement that informs the covered person of the right of the covered person
to file a request for an external review of an adverse determination or final
adverse determination with the director. The statement may explain that external
review is available when the adverse determination or final adverse determination
involves an issue of medical necessity, appropriateness, health care setting,
level of care, or effectiveness. The statement shall include the telephone
number and address of the director.
(3) In addition to the contents required by subsection
(2) of this section, the statement shall inform the covered person that, when
filing a request for an external review, the covered person will be required
to authorize the release of any medical records of the covered person that
may be required to be reviewed for the purpose of reaching a decision on the
external review.

Legislative History

Source: Laws 2013, LB147, § 17.