Health & Safety Code §1371.5(c)
August 28, 2020 5:44 pm(c) The determination as to whether an enrollee reasonably believed that the medical condition was an emergency medical condition that... View more
(c) The determination as to whether an enrollee reasonably believed that the medical condition was an emergency medical condition that... View more
(a)(1) A health care service plan, including a specialized health care service plan, shall reimburse each complete claim, or portion... View more
(C) “An ‘unfair payment pattern,’ as used in this section means any of the following: (2) Engaging in a demonstrable... View more
(h) In determining whether to approve, modify, or deny requests by providers prior to, retrospectively, or concurrent with the provision... View more
(h)(4) Responses regarding decisions to deny, delay, or modify health care services requested by providers prior to, retrospectively, or concurrent... View more
(a) No health care service plan contract that is issued, amended, renewed, or delivered on or after the effective date of... View more
(a) No health care service plan contract that is issued, amended, renewed, or delivered on or after the effective date... View more
This health care provider or the medical director shall review the appeal and, if he or she determines that he... View more
(a)(1) Whenever a health care service plan, including a specialized health care service plan, determines that in reimbursing a claim for... View more
(c) …a healthcare service plan shall not require a provider to obtain authorization prior to the provision of emergency services... View more