IC 27-8-29-12 — Insurer to establish external grievance procedures
Chapter 29. External Review of Grievances
Section text
Sec. 12. An insurer shall establish and maintain an external grievance procedure for the resolution of external grievances regarding the following: (1) The following determinations made by the insurer or an agent of the insurer regarding a service proposed by the treating health care provider: (A) An adverse determination of appropriateness. (B) An adverse determination of medical necessity. (C) A determination that a proposed service is experimental or investigational. (D) A denial of coverage based on a waiver described in IC 27-8-5-2.5(e) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1, 2007, and repealed). (2) The insurer's decision to rescind an accident and sickness insurance policy.
As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.211-2003, SEC.7; P.L.3-2008, SEC.216; P.L.160-2011, SEC.23.
Source: official publisher (2026 edition)