As Amended
SEC. 41-83-25. Health insurance plans; certificate requirement; contract with private review agent; reimbursement under policy where medical necessity in dispute.
(1) Every health insurance plan proposing to issue or deliver a health insurance policy or contract or administer a health benefit program which provides for the coverage of hospital and medical benefits and the utilization review of those benefits shall:
(a) Have a certificate in accordance with this chapter; or
(b) Contract with a private review agent who has a certificate in accordance with this chapter.
(2) Notwithstanding any other provisions of this chapter, for claims where the medical necessity of the provision of a covered benefit is disputed, a health service plan that does not meet the requirements of subsection (1) of this section shall pay any person or hospital entitled to reimbursement under the policy or contract.
SOURCES: Laws, 1990, ch. 347, Sec. 13, eff from and after July 1, 1990.