US Laws, Codes, Statutes & Cases

     72A.285 Claim for insurance benefits; release of summary 
  information. 

    Notwithstanding section 145.64, when a review organization, 
 as defined in section 145.61, has conducted a review of health 
 services given or proposed to be given to an insured or claimant 
 in connection with or in anticipation of a claim for insurance 
 benefits, a complete summary of the review findings must be 
 furnished by the insurer to the provider who requested the 
 review or to the insured or claimant, upon that person's request.

    The summary must list the qualifications of the reviewer, 
 including any license, certification, or specialty designation.  
 The summary must also describe the relationship between the 
 insured's or claimant's diagnosis and the review criteria used 
 as a basis for the claim decision, including the specific 
 rationale for the reviewer's decision.  

    Nothing in this section requires the disclosure of the 
 identity of the person conducting the review. 

    HIST: 1991 c 264 s 3 

Copyright 2005 by the Office of Revisor of Statutes, State of Minnesota.