514J.116 Disclosure requirements. 1. Each health carrier shall include a description of the external review procedures contained in this chapter in or attached to any policy, certificate, membership booklet,outline of coverage, or other evidence of coverage that is provided to a covered person. Thedescription shall be in a format prescribed by the commissioner by rule. 2. The description required by subsection 1 shall include a statement that informs the covered person of the right of the covered person to file a request for an external reviewof an adverse determination or final adverse determination of the health carrier with thecommissioner. The statement shall explain that external review is available when the adverse determination or final adverse determination involves an issue of medical necessity,appropriateness, health care setting, level of care, or effectiveness. The statement shallinclude the telephone number and address of the commissioner. The statement shall alsoinform the covered person that when filing a request for external review, the covered personwill be required to authorize the release of any medical records of the covered person thatmay be required to be m the covered person that when filing a request for external review, the covered personwill be required to authorize the release of any medical records of the covered person thatmay be required to be reviewed for the purpose of reaching a decision on the request forexternal review. 2011 Acts, ch 101, §16Referred to in §514J.104, 514J.120 Sat Dec 23 00:46:19 2023 Iowa Code 2024, Section 514J.116 (15, 0)
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