20-25-1319. Independent dispute resolution procedure -- exemptions. (1) To initiate a dispute resolution procedure under 20-25-1315 through 20-25-1320, the parties shall file a written notice of dispute with the insurance commissioner.
(2) Except as provided in subsection (3), within 30 days after the date of receipt of the notice of dispute, and if no independent reviewer is mutually agreed to by the insurer or health plan and air ambulance service under subsection (3), the insurance commissioner shall appoint an independent reviewer having the qualifications listed in 20-25-1320. The insurance commissioner shall select an independent reviewer randomly from a list established under 20-25-1320.
(3) The insurer or health plan and air ambulance provider may by mutual agreement select an independent reviewer. The parties shall notify the insurance commissioner of the mutually agreed independent reviewer prior to the appointment of an independent reviewer under subsection (2).
(4) An independent reviewer's sole substantive determination under this part is the fair market price of the services that are the subject of the claim.
(5) The independent reviewer may make procedural rulings necessary to regulate the proceedings.
(6) The factors to be used in the independent reviewer's determination are:
(a) the training, qualifications, and composition of the air ambulance service personnel;
(b) the fees for rotor wing or fixed wing services originating or provided entirely within the state of Montana that are:
(i) usually charged by the air ambulance service in Montana;
(ii) usually accepted as payment in full by the air ambulance service in Montana;
(iii) usually charged by other air ambulance services doing business in Montana;
(iv) usually accepted as payment in full by other air ambulance services doing business in Montana; and
(v) usually paid by the insurer or health plan for the service provided in Montana;
(c) whether the air ambulance service was provided in a rural or urban context;
(d) the applicable medicare rate of payment for the services that are the subject of the claim; and
(e) any other factors the independent reviewer determines to be relevant in determining fair market price in accordance with established precedent.
(7) Participation in a dispute resolution procedure under 20-25-1318 through 20-25-1320 exempts an insurer from 33-18-201(6) and (8) and 33-18-232(2).
History: En. Sec. 5, Ch. 231, L. 2017.