Health insurance plans; certificate requirement; contract with private review agent; reimbursement under policy where medical necessity in dispute

1. Law
2. Mississippi Code
3. Public Health
4. Utilization Review of Availability of Hospital Resources and Medical Services
5. Health insurance plans; certificate requirement; contract with private review agent; reimbursement under policy where medical necessity in dispute

1. Every health insurance plan proposing to issue or deliver a health insurance policy or contract or administer a health benefit program which provides for the coverage of hospital and medical benefits and the utilization review of those benefits shall:
   1. Have a certificate in accordance with this chapter; or
   2. Contract with a private review agent who has a certificate in accordance with this chapter.
2. Notwithstanding any other provisions of this chapter, for claims where the medical necessity of the provision of a covered benefit is disputed, a health service plan that does not meet the requirements of subsection (1) of this section shall pay any person or hospital entitled to reimbursement under the policy or contract.

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