Section 27-8-29-12 - Insurer to establish external grievance procedures An insurer shall establish and maintain an external grievance procedure for the resolution of external grievances regarding the following:
(1) The following determinations made by the insurer or an agent of the insurer regarding a service proposed by the treating health care provider: (A) An adverse determination of appropriateness.(B) An adverse determination of medical necessity.(C) A determination that a proposed service is experimental or investigational.(D) A denial of coverage based on a waiver described in IC 27-8-5-2.5(e) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1, 2007, and repealed).(2) The insurer's decision to rescind an accident and sickness insurance policy.Amended by P.L. 160-2011, SEC. 23, eff. 9/23/2010 (retroactive).As added by P.L. 66-2001, SEC.3 and P.L. 203-2001, SEC.14. Amended by P.L. 211-2003, SEC.7; P.L. 3-2008, SEC.216.