HSC § 1371.36
Where this section sits in the code
- Health and Safety Code - HSC
- DIVISION 2. LICENSING PROVISIONS [1200. - 1796.88.]
- CHAPTER 2.2. Health Care Service Plans [1340. - 1399.874.]
- ARTICLE 5. Standards [1367. - 1374.198.]
(a) A health care service plan shall not deny payment of a claim on the basis that the plan, medical group, independent practice association, or other contracting entity did not provide authorization for health care services that were provided in a licensed acute care hospital and that were related to services that were previously authorized, if all of the following conditions are met:
(1) It was medically necessary to provide the services at the time.
(2) The services were provided after the plan’s normal business hours.
(3) The plan does not maintain a system that provides for the availability of a plan representative or an alternative means of contact through an electronic system, including voicemail or electronic mail, whereby the plan can respond to a request for authorization within 30 minutes of the time that a request was made.
(b) This section shall not apply to investigational or experimental therapies, or other noncovered services.
Collected 2026-09-14T05:56:33Z. Source file · JSON