376.1367. Emergency services benefit determination, coverage required, when.
Emergency services benefit determination, coverage required, when.
376.1367. When conducting utilization review or making a benefitdetermination for emergency services:
(1) A health carrier shall cover emergency services necessary toscreen and stabilize an enrollee and shall not require prior authorizationof such services;
(2) Coverage of emergency services shall be subject to applicableco-payments, coinsurance and deductibles;
(3) When an enrollee receives an emergency service that requiresimmediate post evaluation or post stabilization services, a health carriershall provide an authorization decision within sixty minutes of receiving arequest; if the authorization decision is not made within thirty minutes,such services shall be deemed approved.
(L. 1997 H.B. 335)