2003 Minnesota Statutes

     62A.60 Retroactive denial of expenses. 

    In cases where the subscriber or insured is liable for 
 costs beyond applicable co-payments or deductibles, no insurer 
 may retroactively deny payment to a person who is covered when 
 the services are provided for health care services that are 
 otherwise covered, if the insurer or its representative failed 
 to provide prior or concurrent review or authorization for the 
 expenses when required to do so under the policy, plan, or 
 certificate.  If prior or concurrent review or authorization was 
 provided by the insurer or its representative, and the 
 preexisting condition limitation provision, the general 
 exclusion provision and any other coinsurance, or other policy 
 requirements have been met, the insurer may not deny payment for 
 the authorized service or time period except in cases where 
 fraud or substantive misrepresentation occurred. 

    HIST: 1989 c 330 s 20; 1996 c 446 art 1 s 39