(1) An insurer who requires preauthorization or preapproval for coverage under accident and health insurance shall, beginning January 1, 2011, provide an enrollee with a statement of preauthorization if: (a) the applicable CPT codes have been submitted to the insurer to determine whether a particular procedure is covered under the terms of the accident and health insurance policy; (b) the enrollee has met the requirements for preauthorization of the procedure or encounter; and (c) the enrollee requests a statement of preauthorization.
(a) the applicable CPT codes have been submitted to the insurer to determine whether a particular procedure is covered under the terms of the accident and health insurance policy;
(b) the enrollee has met the requirements for preauthorization of the procedure or encounter; and
(c) the enrollee requests a statement of preauthorization.
(2) A statement of preauthorization under Subsection (1) may be sent: (a) by mail; or (b) electronically.
(a) by mail; or
(b) electronically.
(3) A statement of preauthorization shall include a statement that the preauthorization is: (a) not a guarantee of payment by an insurer; and (b) subject to the policy and contract provisions of the accident and health insurance contract.
(a) not a guarantee of payment by an insurer; and
(b) subject to the policy and contract provisions of the accident and health insurance contract.
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