2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS
514J.13 - EFFECT OF EXTERNAL REVIEW DECISION.

        514J.13  EFFECT OF EXTERNAL REVIEW DECISION.
         1.  The review decision by the independent review entity
      conducting the review is binding upon the carrier or organized
      delivery system.  The external review process shall not be considered
      a contested case under chapter 17A, the Iowa administrative procedure
      Act.
         2.  The enrollee or the enrollee's treating health care provider
      acting on behalf of the enrollee may appeal the review decision by
      the independent review entity conducting the review by filing a
      petition for judicial review either in Polk county district court or
      in the district court in the county in which the enrollee resides.
      The petition for judicial review must be filed within fifteen
      business days after the issuance of the review decision.  The
      petition shall name the enrollee or the enrollee's treating health
      care provider as the petitioner.  The respondent shall be the carrier
      or the organized delivery system.  The petition shall not name the
      independent review entity as a party.  The commissioner shall not be
      named as a respondent unless the petitioner alleges action or
      inaction by the commissioner under the standards articulated in
      section 17A.19, subsection 10.  Allegations against the commissioner
      under section 17A.19, subsection 10, must be stated with
      particularity.  The commissioner may, upon motion, intervene in the
      judicial review proceeding.  The findings of fact by the independent
      review entity conducting the review are conclusive and binding on
      appeal.
         3.  The carrier or organized delivery system shall follow and
      comply with the review decision of the independent review entity
      conducting the review, or the decision of the court on appeal.  The
      carrier or organized delivery system and the enrollee's treating
      health care provider shall not be subject to any penalties,
      sanctions, or award of damages for following and complying in good
      faith with the review decision of the independent review entity
      conducting the review or decision of the court on appeal.
         4.  The enrollee or the enrollee's treating health care provider
      may bring an action in Polk county district court or in the district
      court in the county in which the enrollee resides to enforce the
      review decision of the independent review entity conducting the
      review or the decision of the court on appeal.  

         99 Acts, ch 41, §19, 22; 2003 Acts, ch 91, §33