Section 27-8-28-6 - "Grievance" As used in this chapter, "grievance" means any dissatisfaction expressed by or on behalf of a covered individual regarding:
(1) a determination that a service or proposed service is not appropriate or medically necessary;(2) a determination that a service or proposed service is experimental or investigational;(3) the availability of participating providers;(4) the handling or payment of claims for health care services;(5) matters pertaining to the contractual relationship between:(A) a covered individual and an insurer; or(B) a group policyholder and an insurer;(6) an insurer's decision to rescind an accident and sickness insurance policy; or(7) a determination concerning a prior authorization request under IC 27-1-37.5; and for which the covered individual has a reasonable expectation that action will be taken to resolve or reconsider the matter that is the subject of dissatisfaction.
Amended by P.L. 77-2018,SEC. 3, eff. 7/1/2018.Amended by P.L. 160-2011, SEC. 22, eff. 9/23/2010 (retroactive).As added by P.L. 66-2001, SEC.2 and P.L. 203-2001, SEC.13. Amended by P.L. 1-2002, SEC.114.