Section 27-13-10.1-1 - External grievance procedure establishedA health maintenance organization shall establish and maintain an external grievance procedure for the resolution of grievances regarding the following:
(1) The following determinations made by the health maintenance organization or an agent of the health maintenance organization regarding a service proposed by the treating physician:(A) An adverse utilization review determination (as defined in IC 27-8-17-8).(B) An adverse determination of medical necessity.(C) A determination that a proposed service is experimental or investigational.(2) The health maintenance organization's decision to rescind an individual contract or a group contract.Amended by P.L. 160-2011, SEC. 28, eff. 9/23/2010 (retroactive).As added by P.L. 133-1999, SEC.7.