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

Official Publication of the State of Minnesota
Revisor of Statutes