Ind. Code § 27-1-37.5-1.5
This is the official text of Ind. Code § 27-1-37.5-1.5, part of Indiana’s Code — part of the compiled statutory law of Indiana, published by the state as "Code." Browse the sections below, each linked to its official government source.
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"Adverse determination"
Official statutory text
Sec. 1.5. As used in this chapter, "adverse determination" means a decision by a utilization review entity to deny, reduce, or terminate benefit coverage of a health care service furnished or proposed to be furnished to a covered individual on the grounds that the health care service:
(1) is not medically necessary, appropriate, effective, or efficient;
(2) is not being provided in or at an appropriate health care setting or level of care; or
(3) is experimental or investigational.
As added by P.L.190-2023, SEC.14. Amended by P.L.144-2025, SEC.3.
(1) is not medically necessary, appropriate, effective, or efficient;
(2) is not being provided in or at an appropriate health care setting or level of care; or
(3) is experimental or investigational.
As added by P.L.190-2023, SEC.14. Amended by P.L.144-2025, SEC.3.
Status: in_force · Read it on the official government site
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