Section 20-2804 - Utilization review; medically necessary emergency servicesA. A health care services plan engaging in utilization review to determine whether any emergency services rendered by a provider were medically necessary and in accordance with this chapter shall consider the following factors:1. Current emergency medical literature and standards of care.2. Clinical information reasonably available to the provider at the time of the services.B. A health care services plan shall not deny a claim for emergency services on the basis that the services were not medically necessary without review by a physician of the plan's choosing.C. For the purpose of claims payment and utilization review of emergency services, a health care services plan shall have the right to require as a condition of payment that each treating provider produce all of the following: 1. Copies of all medical records pertaining to the emergency services provided to the enrollee.2. Copies of records pertaining to any prior authorization and specialty consultation requests made by the provider.3. A detailed and itemized billing statement.D. If a health care services plan pays any portion of a provider's claim for services rendered to an enrollee, the plan shall not be permitted to recover all or part of that payment from the enrollee, except for:1. The cost of an initial medical screening examination and related charges where the examination determined that emergency services were not medically necessary.2. Payments made as a result of misrepresentation, fraud or clerical error.3. Copayment, coinsurance or deductible amounts that are the responsibility of the enrollee.