40 Pa. Stat. § 1559
Current through P.A. Acts 2023-32
If a subscriber entitled to services provided by a health maintenance organization necessarily incurs expenses for such services while outside the service area, the health maintenance organization to which the person is a subscriber may, in its discretion and if satisfied both as to the necessity for such services and that it was such as the subscriber would have been entitled to under similar circumstances in the service area, reimburse the subscriber or pay on his behalf all or part of the reasonable expenses incurred for such services. Such decision for reimbursement shall be subject to review by the commissioner at the request of a subscriber.
40 P.S. § 1559