IC 27-13-39-3: Written explanation of denial of coverage of experimental treatment; review

Sec. 3. (a) If a health maintenance organization denies coverage for a treatment, procedure, drug, or device on the grounds that the treatment, procedure, drug, or device is experimental, the health maintenance organization shall provide the enrollee with a written explanation that includes the following:

(1) The basis for the denial.

(2) The enrollee's right to appeal the health maintenance organization's decision as provided in IC 27-8-16-8, IC 27-8-17-12, and IC 27-13-10.

(3) The telephone number of:

(A) an individual employed by the health maintenance organization whom; or

(B) a department of the health maintenance organization that;

the enrollee may contact for assistance in initiating an appeal of the health maintenance organization's decision.

(b) An enrollee is entitled to a review that takes not more than seventy-two (72) hours if the enrollee's health situation is life threatening or is an emergency.