As used in this chapter, 'grievance' means any dissatisfaction expressed by or on behalf of a covered individual regarding:(1) a determination that a service or proposed service is not appropriate or medically necessary;(2) a determination that a service or proposed service is experimental or investigational;(3) the availability of participating providers;(4) the handling or payment of claims for health care services;(5) matters pertaining to the contractual relationship between:(A) a covered individual and an insurer; or(B) a group policyholder and an insurer;(6) an insurer's decision to rescind an accident and sickness insurance policy; or(7) a determination concerning a prior authorization request under IC 27-1-37.5;and for which the covered individual has a reasonable expectation that action will be taken to resolve or reconsider the matter that is the subject of dissatisfaction.As added by P.L.66-2001, SEC.2 and P.L.203-2001, SEC.13. Amended by P.L.1-2002, SEC.114; P.L.160-2011, SEC.22; P.L.77-2018, SEC.3.
Indiana Legal Code