58-17H-45 Urgent care requests--Notice of determination--Failure to submit necessary information as ...
Urgent care requests--Notice of determination--Failure to submit necessary
information as grounds for denial of certification.
The health carrier shall notify the covered person
or, if applicable, the covered person's authorized representative, of its determination with respect to
the urgent care request as soon as possible, but in no event more than forty-eight hours after the
The health carrier's receipt of the requested specified information; or
The end of the period provided for the covered person or, if applicable, the covered
person's authorized representative, to submit the requested specified information.
If the covered person or the covered person's authorized representative fails to submit the
information before the end of the period of the extension, as specified in § 58-17H-44, the health
carrier may deny the certification of the requested benefit. 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-32. (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2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub.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 elapsed.")
Source: SL 2011, ch 219, § 70.