State Codes and Statutes

Statutes > California > Ins > 796.01-796.04

INSURANCE CODE
SECTION 796.01-796.04



796.01.  Disability insurers and nonprofit hospital service plans
shall, upon rejecting a claim from a health care provider or a
patient, and upon their demand, disclose the specific rationale used
in determining why the claim was rejected. Nothing in this section is
intended to expand or restrict the ability of a health care provider
or a patient from having health care coverage approved in advance of
services.



796.02.  Compensation of a person retained by a disability insurer
to review claims for health care services shall not be based on
either of the following:
   (a) A percentage of the amount by which a claim is reduced for
payment.
   (b) The number of claims or the cost of services for which the
person has denied authorization or payment.



796.03.  This article does not apply to services or benefits
provided pursuant to Medi-Cal, including services or benefits
provided under Chapters 7 (commencing with Section 14000) and 8
(commencing with Section 14200) of Part 3 of Division 9 of the
Welfare and Institutions Code.



796.04.  A health insurer that provides coverage for hospital,
medical, or surgical expenses that authorizes a specific type of
treatment for services covered under a policyholder's contract or
plan by a provider shall not rescind or modify this authorization
after the provider renders the health care service in good faith and
pursuant to the authorization for any reason, including, but not
limited to, the insurer's subsequent rescission, cancellation, or
modification of the insured's or policyholder's contract or the
insurer's subsequent determination that it did not make an accurate
determination of the insured's eligibility. This section shall not be
construed to expand or alter the benefits available or the terms and
conditions of the contract as may be agreed upon between a
policyholder, certificate holder, or trust, and the insurer. The
Legislature finds and declares that by adopting the amendments made
to this section by Assembly Bill 1324 of the 2007-08 Regular Session
it does not intend to instruct a court as to whether or not the
amendments are existing law.


State Codes and Statutes

Statutes > California > Ins > 796.01-796.04

INSURANCE CODE
SECTION 796.01-796.04



796.01.  Disability insurers and nonprofit hospital service plans
shall, upon rejecting a claim from a health care provider or a
patient, and upon their demand, disclose the specific rationale used
in determining why the claim was rejected. Nothing in this section is
intended to expand or restrict the ability of a health care provider
or a patient from having health care coverage approved in advance of
services.



796.02.  Compensation of a person retained by a disability insurer
to review claims for health care services shall not be based on
either of the following:
   (a) A percentage of the amount by which a claim is reduced for
payment.
   (b) The number of claims or the cost of services for which the
person has denied authorization or payment.



796.03.  This article does not apply to services or benefits
provided pursuant to Medi-Cal, including services or benefits
provided under Chapters 7 (commencing with Section 14000) and 8
(commencing with Section 14200) of Part 3 of Division 9 of the
Welfare and Institutions Code.



796.04.  A health insurer that provides coverage for hospital,
medical, or surgical expenses that authorizes a specific type of
treatment for services covered under a policyholder's contract or
plan by a provider shall not rescind or modify this authorization
after the provider renders the health care service in good faith and
pursuant to the authorization for any reason, including, but not
limited to, the insurer's subsequent rescission, cancellation, or
modification of the insured's or policyholder's contract or the
insurer's subsequent determination that it did not make an accurate
determination of the insured's eligibility. This section shall not be
construed to expand or alter the benefits available or the terms and
conditions of the contract as may be agreed upon between a
policyholder, certificate holder, or trust, and the insurer. The
Legislature finds and declares that by adopting the amendments made
to this section by Assembly Bill 1324 of the 2007-08 Regular Session
it does not intend to instruct a court as to whether or not the
amendments are existing law.



State Codes and Statutes

State Codes and Statutes

Statutes > California > Ins > 796.01-796.04

INSURANCE CODE
SECTION 796.01-796.04



796.01.  Disability insurers and nonprofit hospital service plans
shall, upon rejecting a claim from a health care provider or a
patient, and upon their demand, disclose the specific rationale used
in determining why the claim was rejected. Nothing in this section is
intended to expand or restrict the ability of a health care provider
or a patient from having health care coverage approved in advance of
services.



796.02.  Compensation of a person retained by a disability insurer
to review claims for health care services shall not be based on
either of the following:
   (a) A percentage of the amount by which a claim is reduced for
payment.
   (b) The number of claims or the cost of services for which the
person has denied authorization or payment.



796.03.  This article does not apply to services or benefits
provided pursuant to Medi-Cal, including services or benefits
provided under Chapters 7 (commencing with Section 14000) and 8
(commencing with Section 14200) of Part 3 of Division 9 of the
Welfare and Institutions Code.



796.04.  A health insurer that provides coverage for hospital,
medical, or surgical expenses that authorizes a specific type of
treatment for services covered under a policyholder's contract or
plan by a provider shall not rescind or modify this authorization
after the provider renders the health care service in good faith and
pursuant to the authorization for any reason, including, but not
limited to, the insurer's subsequent rescission, cancellation, or
modification of the insured's or policyholder's contract or the
insurer's subsequent determination that it did not make an accurate
determination of the insured's eligibility. This section shall not be
construed to expand or alter the benefits available or the terms and
conditions of the contract as may be agreed upon between a
policyholder, certificate holder, or trust, and the insurer. The
Legislature finds and declares that by adopting the amendments made
to this section by Assembly Bill 1324 of the 2007-08 Regular Session
it does not intend to instruct a court as to whether or not the
amendments are existing law.