Sec. 8. As used in this chapter, "urgent care situation" means a situation in which a covered individual's treating physician has determined that the covered individual's condition is likely to result in:
(1) adverse health consequences or serious jeopardy to the covered individual's life, health, or safety; or
(2) due to the covered individual's psychological state, serious jeopardy to the life, health, or safety of another individual;
unless treatment of the covered individual's condition for which prior authorization is sought occurs earlier than the period generally considered by the medical profession to be reasonable to treat routine or non-life threatening conditions.
As added by P.L.77-2018, SEC.2.
Structure Indiana Code
Article 1. Department of Insurance
Chapter 37.5. Health Care Service Prior Authorization
27-1-37.5-1. Application of Chapter
27-1-37.5-2. "Covered Individual"
27-1-37.5-4. "Health Care Service"
27-1-37.5-6. "Participating Provider"
27-1-37.5-7. "Prior Authorization"
27-1-37.5-8. "Urgent Care Situation"
27-1-37.5-10. Request for Prior Authorization; Electronic Transmission; Standardized Form
27-1-37.5-11. Response to Request for Prior Authorization; Timing; Incomplete Request
27-1-37.5-12. Claim for Which Prior Authorization Was Given; Denial; Resubmission of Claim
27-1-37.5-14. Contrary Contract Provision Void
27-1-37.5-15. Violation of Chapter
27-1-37.5-16. Department of Insurance; Standardized Prior Authorization Form