Pennsylvania Statutes Title 40 P.S. Insurance § 991.2164. Internal adverse benefit determination process for insurer

(a) Determination process.--An insurer shall establish and maintain an internal adverse benefit determination process that complies with section 2719 of the Public Health Service Act (58 Stat. 682, 42 U.S.C. § 300gg-19) and regulations promulgated under the Public Health Service Act.

(b) Notice.--Following an adverse benefit determination and prior to any appeal of an adverse benefit determination under subsection (a), an insurer shall provide a covered person or covered person's authorized representative notice of the covered person's right to appeal an adverse benefit determination which shall be in a form approved by the department.