{"data":{"id":"us-in/ic-27-1-37.5-1.5","jurisdiction":"us-in","citation":"IC 27-1-37.5-1.5","heading":"\"Adverse determination\"","body":"Sec. 1.5. As used in this chapter, \"adverse determination\" means a decision by a utilization review entity to deny, reduce, or terminate benefit coverage of a health care service furnished or proposed to be furnished to a covered individual on the grounds that the health care service:\n(1) is not medically necessary, appropriate, effective, or efficient;\n(2) is not being provided in or at an appropriate health care setting or level of care; or\n(3) is experimental or investigational.","path":["TITLE 27. INSURANCE","ARTICLE 1. DEPARTMENT OF INSURANCE","Chapter 37.5. Health Care Service Prior Authorization"],"source_url":"https://iga.in.gov/ic/2026/Title_27.html#27-1-37.5-1.5","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"8ab952fc7a97b455c2d1476b2ce7f398db7a949162d2fee722e2d59dfd603c7f","source_id":"us-in","stale":false,"prev":"us-in/ic-27-1-37.5-1","next":"us-in/ic-27-1-37.5-1.6"},"notice":"GroundRules: Original legal text. Not legal advice."}