Section 27-13-39-3 - Written explanation of denial of coverage of experimental treatment; review(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.As added by P.L. 69-1998, SEC.17.