Section 58-17C-27 - Health carrier to provide emergency services coverage without requiringprior authorization--Standards for determining whether emergency medicalcondition exists--Level of coverage.
58-17C-27. Health carrier to provide emergency services coverage without requiring prior authorization--Standards for determining whether emergency medical condition exists--Level of coverage. A health carrier shall cover emergency services necessary to screen and stabilize a covered person and may not require prior authorization of such services if a prudent layperson would have reasonably believed that an emergency medical condition existed. With respect to care obtained from a noncontracting provider within the service area of a managed care plan, a health carrier shall cover emergency services necessary to screen and stabilize a covered person and may not require prior authorization of such services if a prudent layperson would have reasonably believed that use of a contracting provider would result in a delay that would worsen the emergency, or if a provision of federal, state, or local law requires the use of a specific provider. The coverage shall be at the same benefit level as if the service or treatment had been rendered by a participating provider.
A health carrier shall cover emergency services if the plan, acting through a participating provider or other designated representative of the health carrier, has authorized the provision of emergency services.
Source: SL 1999, ch 244, § 2; SL 2003, ch 250, § 13.