Sec. 1.5. As used in this chapter, "adverse determination" means a decision by a utilization review entity to deny, reduce, or terminate benefit coverage of a health care service furnished or proposed to be furnished to a covered individual on the grounds that the health care service: (1) is not medically necessary, appropriate, effective, or efficient; (2) is not being provided in or at an appropriate health care setting or level of care; or (3) is experimental or investigational. As added by P.L.190-2023, SEC.14. Amended by P.L.144-2025, SEC.3.
"Adverse determination"
Ind. Code § 27-1-37.5-1.5, under Health Care Service Prior Authorization.
Ind. Code § 27-1-37.5-1.5