Montana Title 33. Insurance and Insurance Companies § 33-32-210. Qualifications of individuals making or reviewing adverse determinations

(1) A health insurance issuer or its utilization review organization shall ensure that all adverse determinations pursuant to 33-32-211 or 33-32-212 are made by:

(2) A physician or other health care professional making an adverse determination pursuant to subsection (1) must:

(3) A health insurance issuer or its utilization review organization shall ensure that only a physician reviews a grievance as provided under 33-32-308 or 33-32-309.  A physician making an adverse determination or reviewing a grievance must:

(4) A health insurance issuer or its utilization review organization must make all adverse determinations under the clinical direction of one of the utilization review organization's medical directors who is responsible for the oversight of the utilization review activities for covered persons in the state.  A medical director used for this purpose must be a licensed physician.

(5) For the purposes of this section, “adverse determination” has the same meaning as provided in 33-32-102(1)(a) or (1)(c).