§ 1371.36
154 words·~1 min read·
/ca/health-and-safety-code/1371-36A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)A health care service plan shall not deny payment of a claim on the basis that the plan, medical group, independent practice association, or other contracting entity did not provide authorization for health care services that were provided in a licensed acute care hospital and that were related to services that were previously authorized, if all of the following conditions are met:
(1)It was medically necessary to provide the services at the time.
(2)The services were provided after the plan’s normal business hours.
(3)The plan does not maintain a system that provides for the availability of a plan representative or an alternative means of contact through an electronic system, including voicemail or electronic mail, whereby the plan can respond to a request for authorization within 30 minutes of the time that a request was made.
(b)This section shall not apply to investigational or experimental therapies, or other noncovered services.