Nevada Revised Statutes Title 57. Insurance § 695G.241. Circumstances under which adverse determination may be subject to external review; exceptions

1. If a covered person exhausts all procedures set forth in the health care plan for reviewing the adverse determination within the health carrier and the health carrier fails to render a decision within the period required to render that decision set forth in the health care plan; or

2. If the health carrier allows the covered person to submit the adverse determination to the independent review organization without requiring the covered person to exhaust all procedures set forth in the health care plan for reviewing the adverse determination within the health carrier.