3-B.__Prohibition on financial incentives.__A carrier offering a managed care plan in this State may not offer or pay any type of material inducement, bonus or other financial incentive to a participating provider to deny, reduce, withhold, limit or delay specific medically necessary and appropriate health care services covered under the plan to an enrollee.

5.__Independent external review of coverage decisions.__An enrollee who has exhausted all internal grievance and appeal procedures provided by a carrier offering a health plan in this State has the right to an independent external review of a decision under the health plan to deny, reduce or terminate health care coverage or to deny payment for health care services.__ The independent external review is subject to the following requirements.

A.__The decision to be reviewed requires the health plan to incur at least $100 in expenditures and the decision under the health plan to be based on one of the following reasons:

(1)__The health care service is a covered benefit that the carrier has determined to be not medically necessary;

(2)__A limitation is placed on the selection of a health care provider that is claimed by the enrollee to be inconsistent with limits imposed by the health plan and any applicable laws and rules;

(3)__The health care treatment has been determined to be experimental or investigational; or

(4)__The health care service involves a medically based decision that a condition is preexisting.

B.__The independent external review must be requested in writing by the affected enrollee and the enrollee pays a filing fee of not more than $50 that reflects the administrative costs of processing a request for review under this subsection.__The filing fee may be waived or reduced based on a determination by the superintendent that the financial circumstances of the enrollee warrant a waiver or reduction.