58-17H-43 Urgent care requests--Timely notification of determination.
Urgent care requests--Timely notification of determination.
For an urgent care
request, unless the covered person or the covered person's authorized representative has failed to
provide sufficient information for the health carrier to determine whether, or to what extent, the
benefits requested are covered benefits or payable under the health carrier's health benefit plan, the
health carrier shall notify the covered person or, if applicable, the covered person's authorized
representative of the health carrier's determination with respect to the request, whether or not the
determination is an adverse determination, as soon as possible, taking into account the medical
condition of the covered person, but in no event later than twenty-fours hours after the date of the
receipt of the request by the health carrier. If the health carrier's determination is an adverse
determination, the health carrier shall provide notice of the adverse determination in accordance with
§ 58-17H-48. (SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 2011 Session
Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010,
Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final
decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals
Source: SL 2011, ch 219, § 68.