2005 North Carolina Code - General Statutes § 58-3-102. Request for determination of coverage for transplants under health benefit payment mechanisms; required response time; penalties.

§ 58‑3‑102.  Request for determination of coverage for transplants under health benefit payment mechanisms; required response time; penalties.

(a)       As used in this section, "insurer" means any payer of health benefits that is subject to Articles 1 through 66 of this Chapter.

(b)       When a person or that person's health care provider or representative requests that person's insurer to determine whether a transplant is eligible for benefits under that person's health benefit coverage, the insurer shall, within 10 business days after receipt of the request and medical documentation necessary to determine if there is coverage, inform the requesting person as to whether there is coverage; provided coverage exists at the time of the transplant. (1991, c. 644, s. 14.)