§ 41-83-27. Other health insurance policies; certificate requirement; contract with private review agent; reimbursement under policy where medical necessity in dispute
Every insurer proposing to issue or deliver a health insurance policy or contract or administer a health benefit program which provides for the coverage of hospital and medical benefits and the utilization review of such benefits shall:
Have a certificate in accordance with this chapter; or
Contract with a private review agent that has a certificate in accordance with this chapter.
Notwithstanding any provision of this chapter, for claims where the medical necessity of the provision of a covered benefit is disputed, an insurer that does not meet the requirements of subsection (1) of this section shall pay any person or hospital entitled to reimbursement under the policy or contract.
