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2020 Delaware Code
Title 18 - Insurance Code
Chapter 33. Health Insurance Contracts
Subchapter II. Pre-Authorization Transparency
§ 3375 Retrospective denial.
Universal Citation:
18 DE Code § 3375. (2020)
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§ 3375. Retrospective denial.
The utilization review entity may not revoke, limit, condition or restrict a pre-authorization on ground of medical necessity after the date the health-care provider received the pre-authorization. Any language attempting to disclaim payment for services on the basis of changes to medical necessity that have been pre-authorized and delivered while under coverage shall be null and void. A proper notification of policy changes validly delivered as per § 3372 of this title may void a pre-authorization if received after pre-authorization but before delivery of the service.
80 Del. Laws, c. 310, § 1;
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