Section 1371.36 - Denial of claim on basis that authorization not provided(a) A health care service plan shall not deny payment of a claim on the basis that the plan, medical group, independent practice association, or other contracting entity did not provide authorization for health care services that were provided in a licensed acute care hospital and that were related to services that were previously authorized, if all of the following conditions are met: (1) It was medically necessary to provide the services at the time.(2) The services were provided after the plan's normal business hours.(3) The plan does not maintain a system that provides for the availability of a plan representative or an alternative means of contact through an electronic system, including voicemail or electronic mail, whereby the plan can respond to a request for authorization within 30 minutes of the time that a request was made.(b) This section shall not apply to investigational or experimental therapies, or other noncovered services.Ca. Health and Saf. Code § 1371.36
Amended by Stats 2015 ch 303 (AB 731),s 257, eff. 1/1/2016.Added by Stats 2000 ch 827 (AB 1455), s 5, eff. 1/1/2001.Stats 2000 ch 825 (SB 1177), s 5 also added this section.