31A-22-639. Statement of preauthorization.

148 words·~1 min read·/ut/title-31a/chapter-22/31a-22-639·

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(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.

(2)A statement of preauthorization under Subsection

(1)may be sent:

(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.

Enacted by Chapter 204 , 2010 General Session