§ 58-3-172. Notice of claim denied. - North Carolina Statutes

§ 58‑3‑172. Notice of claim denied.

(a)        For all claimsdenied for health care provider services under health benefit plans, writtennotification of the denied claim shall be given to the insured and to thehealth care provider submitting the claim if the health care provider wouldotherwise be eligible for payment. This subsection does not apply to insurerssubject to G.S. 58‑3‑225.

(b)        For purposes ofthis section, "health benefit plans" means accident and healthinsurance policies or certificates; nonprofit hospital or medical servicecorporation contracts; health, hospital, or medical service corporation plancontracts; health maintenance organization (HMO) subscriber contracts and otherplans provided by managed‑care organizations; plans provided by a MEWA orplans provided by other benefit arrangements, to the extent permitted by ERISA;and the State Health Plan for Teachers and State Employees and any optionalplans or programs operating under Part 2 of Article 3 of Chapter 135 of theGeneral Statutes. (1993,c. 529, s. 4.2; 1993 (Reg. Sess., 1994), c. 678, s. 6; 2000‑162, s. 4(c);2007‑298, s. 8.3; 2007‑323, s. 28.22A(o); 2007‑345, s. 12.)