{"data":{"id":"us-in/ic-27-13-10.1-1","jurisdiction":"us-in","citation":"IC 27-13-10.1-1","heading":"External grievance procedure established","body":"Sec. 1. A health maintenance organization shall establish and maintain an external grievance procedure for the resolution of grievances regarding the following:\n(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:\n(A) An adverse utilization review determination (as defined in IC 27-8-17-8).\n(B) An adverse determination of medical necessity.\n(C) A determination that a proposed service is experimental or investigational.\n(2) The health maintenance organization's decision to rescind an individual contract or a group contract.","path":["TITLE 27. INSURANCE","ARTICLE 13. HEALTH MAINTENANCE ORGANIZATIONS","Chapter 10.1. External Review of Grievances"],"source_url":"https://iga.in.gov/ic/2026/Title_27.html#27-13-10.1-1","current_through":"2026","vintage":"2026","retrieved_at":"2026-09-25T05:39:04Z","sha256":"321f6cdc78b88ae5c4f2638a8fdd816093158f0af08be69e1bb162ff53c5c1fb","source_id":"us-in","stale":false,"prev":"us-in/ic-27-13-10.1-0.1","next":"us-in/ic-27-13-10.1-2"},"notice":"GroundRules: Original legal text. Not legal advice."}