Section 550.1923 – Maintenance of Records; Report to Director.
550.1923 Maintenance of records; report to director. Sec. 23. (1) An independent review organization assigned to conduct an external review under section 11 or 13 shall maintain for 3 years written records in the aggregate and by health carrier on all requests for external review for which it conducted an external review during a calendar […]
Section 550.1925 – Description of Internal Grievance and External Review Procedures; Inclusion With Materials Provided to Covered Persons.
550.1925 Description of internal grievance and external review procedures; inclusion with materials provided to covered persons. Sec. 25. (1) A health carrier shall include a description of the internal grievance and external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage it provides to covered […]
Section 550.1927 – Rules.
550.1927 Rules. Sec. 27. The director may promulgate rules under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328, necessary to carry out this act. History: 2000, Act 251, Eff. Oct. 1, 2000 ;– Am. 2016, Act 274, Eff. Sept. 29, 2016
Section 550.1929 – Cease and Desist Order; Additional Orders; Fines; Hearing; Injunction; Creation of Cancer Clinical Trials; Disposition of Funds.
550.1929 Cease and desist order; additional orders; fines; hearing; injunction; creation of cancer clinical trials; disposition of funds. Sec. 29. (1) If the commissioner finds that a violation of this act has occurred, the commissioner shall reduce the findings and decision to writing and shall issue and cause to be served upon the person charged […]
Section 550.1903 – Definitions.
550.1903 Definitions. Sec. 3. As used in this act: (a) “Adverse determination” means a determination by a health carrier or its designee utilization review organization that an admission, availability of care, continued stay, or other health care service that is a covered benefit has been reviewed and, based on the information provided, does not meet […]
Section 550.1905 – Scope.
550.1905 Scope. Sec. 5. (1) Except as otherwise provided in subsection (2), this act applies to all health carriers. (2) This act does not apply to a policy or certificate that provides coverage only for specified accident or accident-only coverage, credit, disability income, hospital indemnity, long-term care insurance, as that term is defined in section […]
Section 550.1907 – Right to Request External Review for Adverse Determination; Written Notice.
550.1907 Right to request external review for adverse determination; written notice. Sec. 7. (1) A health carrier shall provide written notice to a covered person of the internal grievance and external review processes at the time the health carrier sends written notice of an adverse determination. (2) Except as provided in subsection (3)(a), a request […]
Section 550.1909 – Written Request to Director; Manner; Electronic Communication.
550.1909 Written request to director; manner; electronic communication. Sec. 9. (1) Except for a request for an expedited external review under section 13, all requests for external review must be made in writing to the director. (2) A written notice required to be provided under this act must be provided in a culturally and linguistically […]
Section 550.1911 – Request for External Review; Commencement; Preliminary Review; Notice of Acceptance; Duties of Director; Incomplete Request; Nonacceptance; Assignment of Independent Review Organization; Duty of Health Carrier to Provide Documents; Reconsideration by Health Carrier of Its Adverse Determination; Recommendation; Considerations; Review by Director; Notice of Decision.
550.1911 Request for external review; commencement; preliminary review; notice of acceptance; duties of director; incomplete request; nonacceptance; assignment of independent review organization; duty of health carrier to provide documents; reconsideration by health carrier of its adverse determination; recommendation; considerations; review by director; notice of decision. Sec. 11. (1) Not later than 60 days or, after […]
Section 550.1913 – Expedited External Review.
550.1913 Expedited external review. Sec. 13. (1) Except as provided in subsection (12), a covered person or the covered person’s authorized representative may make a request for an expedited external review with the director within 10 days after the covered person receives an adverse determination if both of the following apply: (a) The adverse determination […]