Indiana Code 27-8-28-6. “Grievance”
(1) a determination that a service or proposed service is not appropriate or medically necessary;
Terms Used In Indiana Code 27-8-28-6
- accident and sickness insurance policy: means an insurance policy that provides one (1) or more of the kinds of insurance described in Class 1(b) and 2(a) of IC 27-1-5-1. See Indiana Code 27-8-28-1
- covered individual: means an individual who is covered under an accident and sickness insurance policy. See Indiana Code 27-8-28-3
- insurer: means any person who delivers or issues for delivery an accident and sickness insurance policy or certificate in Indiana. See Indiana Code 27-8-28-9
(3) the availability of participating providers;
(4) the handling or payment of claims for health care services;
(5) matters pertaining to the contractual relationship between:
(A) a covered individual and an insurer; or
(B) a group policyholder and an insurer;
(6) an insurer’s decision to rescind an accident and sickness insurance policy; or
(7) a determination concerning a prior authorization request under IC 27-1-37.5;
and for which the covered individual has a reasonable expectation that action will be taken to resolve or reconsider the matter that is the subject of dissatisfaction.
As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.1-2002, SEC.114; P.L.160-2011, SEC.22; P.L.77-2018, SEC.3.