Health care service plans shall, upon rejecting a claim from a health care provider or a patient, and upon their demand, disclose the specific rationale used in determining why the claim was rejected. Nothing in this section is intended to expand or restrict the ability of a health care provider or a patient from having health care coverage approved in advance of services.
Cal. Health & Safety Code § 1399.55
Claims Reviewers
Known as the Knox-Keene Health Care Service Plan Act
The act spans §§ 1340–1399 (617 sections).
Added by Stats. 1992, Ch. 544, Sec. 1
Official source: California Legislative Information. Reproduced from public-domain California statutes; confirm against the official source for the current text. Not legal advice.