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Rule 20:06:53:66 Funding for external review.

          20:06:53:66.  Funding of external review. The health carrier against which a request for any review subject to this chapter is filed shall pay the cost of the independent review organization for conducting the external review. The covered person must pay a filing fee for each request for a review of $25 to the health carrier. The filing fee must accompany the request for external review to the director. The filing fees for a covered person may not exceed $75 for any single plan year. The filing fee is waived if the director determines that the filing fee would impose an undue financial hardship. The filing fee must be refunded if the adverse determination is reversed through external review or the request is determined ineligible for an external review.

 

          Source: 37 SDR 48, effective September 22, 2010; 37 SDR 241, effective July 1, 2011; 38 SDR 102, effective December 7, 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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