695G.290 - Decision in favor of insured binding on managed care organization; limitation of liability; cost for external review organization.

695G.290  Decision in favor of insured binding on managed care organization; limitation of liability; cost for external review organization.

1.  If the determination of an external review organization concerning an external review of a final adverse determination is in favor of the insured, the determination is final, conclusive and binding upon the managed care organization.

2.  An external review organization or any clinical peer who conducts or participates in an external review of a final adverse determination for the external review organization is not liable in a civil action for damages relating to a determination made by the external review organization if the determination is made in good faith and without gross negligence.

3.  The cost of conducting an external review of a final adverse determination pursuant to NRS 695G.241 to 695G.310, inclusive, must be paid by the managed care organization that made the final adverse determination.

(Added to NRS by 2003, 782)