The health insurance organization or issuer against which a request for a standard external review or an expedited external review is filed shall be required to pay the independent review organization for conducting the external review.\nThe Office of the Insurance Commissioner shall notify health service organizations and issuers the costs of the process or any modification thereof within one hundred twenty (120) days in advance.\nA covered person or enrollee shall pay not more than twenty-five dollars ($25) for each review. Provided, That the same covered person or enrollee shall not pay more than seventy-five dollars ($75) per policy year. The amount paid by the covered person or enrollee shall be reimbursed to him/her if a decision is made in his/her favor.\nHistory —Aug. 29, 2011, No. 194, added as § 28.170 on Aug. 23, 2012, No. 203, § 7, eff. 90 days after Aug. 23, 2012.
Puerto Rico Legal Code