§ 23-99-507 - Medical necessity.
23-99-507. Medical necessity.
(a) The criteria for medical necessity determinations for mental illness made under a health benefit plan shall be made available by the health care insurer in accordance with rules established by the Insurance Commissioner to any current or potential covered individual or contracting provider upon request.
(b) On request, the reason for a denial of reimbursement or payment for services to diagnose or treat mental illness under a health benefit plan shall be made available by the health care insurer to a covered individual in accordance with the rules of the commissioner.