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Indiana Code Title 27. Insurance § 27-1-37.5-1.5

Current as of January 02, 2024 | Updated by Findlaw Staff

Sec. 1.5. As used in this chapter, “adverse determination” means a decision by a utilization review entity to deny, reduce, or terminate benefit coverage of a health care service furnished or proposed to be furnished to a covered individual on the grounds that the health care service:

(1) is not medically necessary, appropriate, effective, or efficient;

(2) is not being provided in or at an appropriate health care setting or level of care;  or

(3) is experimental or investigational.

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Cite this article: FindLaw.com - Indiana Code Title 27. Insurance § 27-1-37.5-1.5 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-1-5/

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