New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter XVIII - External Appeals Of Adverse Determinations Of Health Care Plans
Part 410 - External Appeals Of Adverse Determinations Of Health Care Plans
Section 410.1 - Preamble
Universal Citation: 11 NY Comp Codes Rules and Regs ยง 410.1
Current through Register Vol. 46, No. 12, March 20, 2024
Insureds, and in the case of a retrospective adverse determination, an insured's health care provider shall have the right to request an external appeal of a final adverse determination which is made by a health care plan on the grounds that the health care service is not medically necessary or is experimental or investigational. This Part shall be applicable to health care plans as defined in subdivision d-5 of section 4900 of the Insurance Law and to external appeal agents certified pursuant to title II of article 49 of the Insurance Law and Public Health Law and this Part and to applicants for certification as external appeal agents.
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