IN HMO Affidavit – Retroactive Denial for Authorized Care
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: IN HMOs
AFFIDAVIT OF COMPLIANCE Retroactive Denial of Authorized Services Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Health Plan or Contracted Entity has met the provisions of... View more
IN HMO Affidavit – Untimely Payment
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: IN HMOs
AFFIDAVIT OF COMPLIANCE Prompt Payment to Providers Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Health Plan or Contracted Entity has met the provisions of IN... View more
IN HMO Appeal – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: IN HMOs
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Indiana Department of Insurance for ’s failure to remit automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per IN Code §27-8-5.7-6(a), was required to reimburse within the... View more
IN HMO Appeal – Maternity Coverage
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: IN HMOs
URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Indiana Department of Insurance for ’s failure to provide coverage for maternity services and care as required by state law. Our investigation has concluded the following: Under existing Indiana law, has a duty to provide all... View more
IN HMO Appeal – Medical Necessity – Qualified Reviewers
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: IN HMOs
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Indiana Department of Insurance for ’s failure to reimburse medically necessary services as required by state law. Our investigation has concluded the following: Please be advised that our treating physician was a . However, your reviewer was... View more
IN HMO Appeal – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: IN HMOs
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Indiana Department of Insurance for ’s failure to reimburse emergency services as required by state law. Our investigation has concluded the following: IN Code §27-13-1-11.7 defines “emergency services and care” as: “Emergency” means a medical condition that... View more
IN HMO Appeal – Non-urgent Authorization Timeframes
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: IN HMOs
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Indiana Department of Insurance for ’s failure to meet the timeframe and notice requirements for non-urgent authorization requests as required by state law. Our investigation has concluded the following: THIS REQUEST IS NOW DAYS IN VIOLATION OF... View more
IN HMO Appeal – Notice Requirements for Adverse Determinations
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: IN HMOs
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Indiana Department of Insurance for ’s failure to reimburse medically necessary services and meet notice requirements as required by state law. Our investigation has concluded the following: On , denied this claim as not medically necessary. To... View more
IN HMO Appeal – Poststabilization Timeframe
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: IN HMOs
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Indiana Department of Insurance for ’s failure to reimburse emergency and/or statutorily granted post-stabilization services and care as required by state law. Our investigation has concluded the following: TO DATE, HAS FAILED TO REIMBURSE EMERGENCY AND STATUTORILY... View more
IN HMO Appeal – Refund Recoupment
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: IN HMOs
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Indiana Department of Insurance for ’s failure to properly reimburse medically necessary services as required by state law. Our investigation has concluded the following: Please be advised that must substantiate how it reached its overpayment determination and... View more