20:06:47:03. Unacceptable claims
procedures. The claims procedures may not contain any provisions or be
administered in a method that unduly inhibits or hampers the initiation or
processing of claims for benefits such as:
a claim for lack of prior authorization in circumstances where obtaining
authorization could seriously jeopardize the life or health of the covered
person or the ability of the covered person to regain maximum function;
an authorized representative from acting on behalf of a covered person;
the filing of more than two appeals of an adverse benefit determination prior
to taking civil action;
fees or costs for voluntary appeals.
Source: 30 SDR 39, effective September
28, 2003; 37 SDR 241, effective July 1, 2011.
General Authority: SDCL 58-17H-49.
Law Implemented: SDCL 58-17H-49.