Utah Admin. Code R590-261-5 - Notice of Right to Independent Review

(1) A carrier shall provide written notice of a claimant's right to an independent review with each notice of rescission of coverage or final adverse benefit determination.

(2) The notice in Subsection (1) shall include the following, or substantially equivalent, statement:

"We have rescinded your coverage or denied your request for the provision of or payment for a health care service or course of treatment. You may have the right to have our decision reviewed by a health care professional who has no association with us if our decision involved making a judgment as to the medical necessity, appropriateness, health care setting, level of care, or effectiveness of the health care service or treatment you requested. To receive additional information about an independent review, visit https://insurance.utah.gov/consumer/health/independent-review or contact the Utah Insurance Department by mail at 4315 S. 2700 W., Suite 2300, Taylorsville, UT 84129; by phone at 801-957-9280; or by email at healthappeals@utah.gov."

Notes

Utah Admin. Code R590-261-5

Amended by Utah State Bulletin Number 2023-10, effective 5/9/2023