Sec. 1.5. As used in this chapter, "adverse determination" means a decision by a utilization review entity to deny, reduce, or terminate benefit coverage of a health care service furnished or proposed to be furnished to a covered individual on the grounds that the health care service: (1) is not medically necessary, appropriate, effective, or efficient; (2) is not being provided in or at an appropriate health care setting or level of care; or (3) is experimental or investigational.
‹ Prev All Indiana sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.