External grievance procedure established

Sec. 1. A 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. As added by P.L.133-1999, SEC.7. Amended by P.L.160-2011, SEC.28.