§2444. Funding of external review
A. The health insurance issuer against which a request for a standard external review
or an expedited external review is filed shall pay the cost of the independent review
organization for conducting the external review, and no fee or other charge may be levied
upon a covered person for any costs of an external review.
B.(1) The amount charged by the independent review organization as the cost to be
paid by the health insurance issuer shall be a reasonable amount for the actual review
performed. The independent review organization shall provide adequate documentation to
the health insurance issuer justifying the amount charged.
(2) A health insurance issuer that believes that the amount charged for a review by
an independent review organization is not reasonable may appeal those charges to the
commissioner. In conducting the appeal, the commissioner shall review the amount
charged, make a determination regarding the reasonableness of the amount charged, and, if
warranted, may order an appropriate reduction. The commissioner may request additional
information from the independent review organization, the health insurance issuer, or other
independent review organizations or healthcare providers in making his determination.
Acts 2013, No. 326, §1, eff. Jan. 1, 2015; Acts 2017, No. 35, §1.