{"data":{"id":"us-nc/n.c.-gen.-stat.-58-50-79","jurisdiction":"us-nc","citation":"N.C. Gen. Stat. § 58-50-79","heading":"Exhaustion of internal grievance process.","body":"(a)\tExcept as provided in G.S. 58-50-82, a request for an external review under G.S. 58-50-80 or G.S. 58-50-82 shall not be made until the covered person has exhausted the insurer's internal appeal and grievance processes under G.S. 58-50-61 and G.S. 58-50-62.\n(b)\tA covered person shall be considered to have exhausted the insurer's internal grievance process for purposes of this section, if the covered person:\n(1)\tHas filed a second-level grievance involving a noncertification appeal decision under G.S. 58-50-61 and G.S. 58-50-62, and\n(2)\tExcept to the extent the covered person requested or agreed to a delay, has not received a written decision on the grievance from the insurer within 60 days since the date the covered person can demonstrate that a grievance was filed with the insurer.\n(c)\tNotwithstanding subsection (b) of this section, a covered person may not make a request for an external review of a noncertification involving a retrospective review determination made under G.S. 58-50-61 until the covered person has exhausted the insurer's internal grievance process.\n(d)\tA request for an external review of a noncertification may be made before the covered person has exhausted the insurer's internal grievance and appeal procedures under G.S. 58-50-61 and G.S. 58-50-62 whenever the insurer agrees to waive the exhaustion requirement. If the requirement to exhaust the insurer's internal grievance procedures is waived, the covered person may file a request in writing for a standard external review as set forth in G.S. 58-50-80 or may make a request for an expedited external review as set forth in G.S. 58-50-82. In addition, the insurer may choose to eliminate the second-level grievance review under G.S. 58-50-62. In such case, the covered person may file a request in writing for a standard external review under G.S. 58-50-80 or may make a request for an expedited external review as set forth in G.S. 58-50-82 within 60 days after receiving notice of an appeal decision upholding a noncertification. (2001-446, s. 4.5; 2009-382, s. 25.)","path":["Chapter 58. Insurance.","Article 50. General Accident and Health Insurance Regulations.","Part 4. Health Benefit Plan External Review."],"source_url":"https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_58/GS_58-50-79.html","current_through":"S.L. 2026-30","vintage":"","retrieved_at":"2026-08-27T18:06:53Z","sha256":"928a0052beee532b9784c4c00ffd9582a4c5bf71968577695c5a11dc4b47dae9","source_id":"us-nc","stale":false,"prev":"us-nc/n.c.-gen.-stat.-58-50-78","next":"us-nc/n.c.-gen.-stat.-58-50-80"},"notice":"GroundRules: Original legal text. Not legal advice."}