§ 36-2-401 Single means of establishing parentage — Legislative intent
§ 36-2-402 Part definitions
§ 36-2-403 Establishing embryo parentage — Relinquishment of rights and responsibilities

Terms Used In Tennessee Code > Title 36 > Chapter 2 > Part 4

  • Adverse determination: means :

    • (A) A determination by a health carrier or its designee utilization review organization that, based upon the information provided, a request for a benefit under the health carrier's health benefit plan does not meet the health carrier's requirements for medical necessity, appropriateness, healthcare setting, level of care or effectiveness and the requested benefit is therefore denied, reduced or terminated or payment is not provided or made, in whole or in part, for the benefit. See Tennessee Code 56-61-102

    • Aggrieved person: means :

      • (A) A healthcare provider. See Tennessee Code 56-61-102

      • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-61-102
      • Contract: A legal written agreement that becomes binding when signed.
      • Covered person: means a policyholder, subscriber, enrollee or other individual participating in a health benefit plan. See Tennessee Code 56-61-102
      • Donor: The person who makes a gift.
      • Embryo parentage: means the acceptance of rights and responsibilities for an embryo by a recipient intended parent. See Tennessee Code 36-2-402
      • Embryo transfer: means the medical procedure of physically placing an embryo into the uterus of a female recipient intended parent. See Tennessee Code 36-2-402
      • Emergency services: means healthcare items and services furnished or required to evaluate and treat an emergency medical condition. See Tennessee Code 56-61-102
      • Facility: means an institution licensed under title 68 providing healthcare services or a healthcare setting, including but not limited to, hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation. See Tennessee Code 56-61-102
      • Final adverse determination: means an adverse determination involving a covered benefit that has been upheld by a health carrier at the completion of the health carrier's internal grievance process procedures as set forth in this chapter. See Tennessee Code 56-61-102
      • Grievance: means a written appeal of an adverse determination or final adverse determination submitted by or on behalf of a covered person regarding:

        • (A) Availability, delivery or quality of healthcare services regarding an adverse determination. See Tennessee Code 56-61-102

        • Health carrier: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits or healthcare services. See Tennessee Code 56-61-102
        • human embryo: means an individual fertilized ovum of the human species from the single-cell stage to eight-week development. See Tennessee Code 36-2-402
        • Legal embryo custodian: means the person or entity, including an embryo transfer clinic, who hold the legal rights and responsibilities for a human embryo and who relinquishes said embryo to another person. See Tennessee Code 36-2-402
        • legal transfer of rights to an embryo: means the relinquishment of rights and responsibilities by the person or persons who hold the legal rights and responsibilities for an embryo. See Tennessee Code 36-2-402
        • medical necessity: means healthcare services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are:

          • (A) In accordance with generally accepted standards of medical practice. See Tennessee Code 56-61-102

          • Parent: means the biological mother or biological father of a child, regardless of the marital status of the mother and father. See Tennessee Code 36-2-302
          • Person: includes a corporation, firm, company or association. See Tennessee Code 1-3-105
          • Person: means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity or any combination of the entities listed in this subdivision (28). See Tennessee Code 56-61-102
          • Prospective review: means utilization review conducted prior to an admission or the provision of a healthcare service or a course of treatment in accordance with a health carrier's requirement that the healthcare service or course of treatment, in whole or in part, be approved prior to its provision or admission. See Tennessee Code 56-61-102
          • provider: means a healthcare professional or a facility. See Tennessee Code 56-61-102
          • Recipient intended parent: means a person or persons who receive a relinquished embryo and who accepts full legal rights and responsibilities for such embryo and any child that may be born as a result of embryo transfer. See Tennessee Code 36-2-402
          • Retrospective review: means any review of a request for a benefit that is not a prospective review request. See Tennessee Code 56-61-102
          • signed: includes a mark, the name being written near the mark and witnessed, or any other symbol or methodology executed or adopted by a party with intention to authenticate a writing or record, regardless of being witnessed. See Tennessee Code 1-3-105
          • written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105