LD 531
pg. 2
An Act to Require External Review of Coverage Decisions by Health Plans
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LR 707
Item 1
E.__The independent review organization shall issue to the
health plan and to the enrollee a written review decision
based on the evidence presented.__The decision of the review
organization is binding on the health plan and the enrollee.
F.__The superintendent may develop additional standards and
adopt rules to set the fee required in paragraph B and to
adopt other rules as necessary to carry out the purposes of
this subsection in accordance with section 4309.
SUMMARY
This bill amends the Health Plan Improvement Act to give a
health plan enrollee the right to an independent external review
of a plan's coverage decision after all internal grievance and
appeals procedures have been exhausted.
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