§ 58-3-102. Request for determination of coverage for transplants under health benefit payment mechanisms; required response time; penalties. - North Carolina Statutes

§58‑3‑102.  Request for determination of coverage for transplantsunder health benefit payment mechanisms; required response time; penalties.

(a)        As used in thissection, "insurer" means any payer of health benefits that is subjectto Articles 1 through 66 of this Chapter.

(b)        When a person orthat person's health care provider or representative requests that person'sinsurer to determine whether a transplant is eligible for benefits under thatperson's health benefit coverage, the insurer shall, within 10 business daysafter receipt of the request and medical documentation necessary to determineif there is coverage, inform the requesting person as to whether there iscoverage; provided coverage exists at the time of the transplant. (1991,c. 644, s. 14.)