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Delaware Code Title 18. Insurance Code § 3585. Retrospective denial

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The utilization review entity may not revoke, limit, condition or restrict a pre-authorization on ground of medical necessity after the date the health-care provider received the pre-authorization. Any language attempting to disclaim payment for services on the basis of changes to medical necessity that have been pre-authorized and delivered while under coverage shall be null and void. A proper notification of policy changes validly delivered as per § 3372 of this title may void a pre-authorization if received after pre-authorization but before delivery of the service.

Cite this article: - Delaware Code Title 18. Insurance Code § 3585. Retrospective denial - last updated January 01, 2022 |

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