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 §§ 2801–2847 (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.