(1) the health care plan;
(2) any officer, director, or management employee of the health care
plan;
(3) any health care provider, physician's medical group, independent
practice association, or provider of pharmaceutical products or services
or durable medical equipment, proposing to provide or supply the health
service;
(4) the facility at which the health service would be provided;
(5) the developer or manufacturer of the principal health service
which is the subject of the appeal; or
(6) the insured whose health care service is the subject of the
appeal, or the insured's designee.
(b) Notwithstanding subsection (a) of this section, the superintendent
shall promulgate regulations to minimize any conflict of interest where
such conflict may be unavoidable.
Structure New York Laws
Article 49 - Utilization Review and External Appeal
Title 2 - Right to External Appeal
4910 - Right to External Appeal Established.
4911 - Powers of the Superintendent.
4912 - Standards for Certification.
4914 - Procedures for External Appeals of Adverse Determinations.
4916 - Oversight and Surveillance of the External Appeal Process.