A policy or certificate issued or renewed after April 8, 1994 may not contain a provision that permits, upon retroactive review and confirmation of medical necessity, the imposition of a penalty of more than $500 for failure to provide notification under a utilization review program. This section does not limit the right of insurers to deny a claim when appropriate prospective or retroactive review concludes that services or treatment rendered were not medically necessary.
Me. Rev. Stat. tit. 24-A, § 2847-D
Penalty for noncompliance with utilization review programs
Known as the Group or Blanket Health Insurance Law
The act spans §§ 2801 to 2847-X (103 sections).
PL 1993, c. 645, §B5 (NEW)
Official source: Maine Legislature. Reproduced from public-domain Maine statutes; confirm against the official source for the current text. Not legal advice.