IC 27-13-10.1-1: 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.