20:06:53:54. Binding nature of external review decision. An external review decision is binding on the health carrier except to the extent the health carrier has other remedies available under applicable state law. An external review decision is binding on the covered person except to the extent the covered person has other remedies available under applicable federal or state law.
A covered person or the covered person's authorized representative may not file a subsequent request for external review involving the same adverse determination or final adverse determination for which the covered person has already received an external review decision pursuant to this chapter.
Source: 37 SDR 48, effective September 22, 2010; 37 SDR 241, effective July 1, 2011.
General Authority: SDCL 58-17-87, 58-17H-49, 58-17I-16, 58-18-79.
Law Implemented: SDCL 58-17-87, 58-18-79.
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