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Senate Bill 0365


 

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Senate Bill 0365

ARCHIVE (2001)

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DIGEST OF SB365 (Updated April 12, 2001 7:46 PM - DI 84)

Health insurance grievance review. Requires a utilization review agent to, under certain circumstances, supply a provider of record upon request and an enrollee with notice of the enrollee's right to appeal and a written description of the appeals procedure at the time an adverse utilization review determination is made. Specifies that the exclusive right to review of a utilization review determination for an individual covered under an accident and sickness insurance policy or a health maintenance organization contract is through the accident and sickness insurer's or health maintenance organization's internal and external grievance procedures. Requires an accident and sickness insurer to establish and maintain an internal grievance procedure and an external grievance review procedure. Provides for expedited and standard reviews. Establishes requirements for independent review organizations to be certified by the department of insurance. Requires accident and sickness insurers to report certain information regarding grievances to the commissioner of the department of insurance.
    Current Status:
     Law Enacted
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