"Grievance"

Sec. 6. 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. As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.1-2002, SEC.114; P.L.160-2011, SEC.22; P.L.77-2018, SEC.3.