695G.012 - “Adverse determination” defined.
695G.012 “Adverse determination” defined. “Adverse determination” means a determination of a managed care organization to deny all or part of a service or procedure that is proposed or being provided to an insured on the basis that it is not medically necessary or appropriate or is experimental or investigational. The term does not include a determination of a managed care organization that such an allocation is not a covered benefit.
(Added to NRS by 2003, 779)