NRS 689A.0403
Procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations.

1.

Each policy of health insurance must include a procedure for binding arbitration to resolve disputes concerning independent medical evaluations pursuant to the rules of the American Arbitration Association.

2.

If an insurer, for any final determination of benefits or care, requires an independent evaluation of the medical, dental or chiropractic care of any person for whom such care is covered under the terms of the contract of insurance, only a physician, dentist or chiropractor who is certified to practice in the same field of practice as the primary treating physician, dentist or chiropractor or who is formally educated in that field may conduct the independent evaluation.

3.

The independent evaluation must include a physical examination of the patient, unless the patient is deceased, and a personal review of all X-rays and reports prepared by the primary treating physician, dentist or chiropractor. A certified copy of all reports of findings must be sent to the primary treating physician, dentist or chiropractor and the insured person within 10 working days after the evaluation. If the insured person disagrees with the finding of the evaluation, the insured person must submit an appeal to the insurer pursuant to the procedure for binding arbitration set forth in the policy of insurance within 30 days after the insured person receives the finding of the evaluation. Upon its receipt of an appeal, the insurer shall so notify in writing the primary treating physician, dentist or chiropractor.

4.

The insurer shall not limit or deny coverage for care related to a disputed claim while the dispute is in arbitration, except that, if the insurer prevails in the arbitration, the primary treating physician, dentist or chiropractor may not recover any payment from either the insurer, insured person or the patient for services that the primary treating physician, dentist or chiropractor provided to the patient after receiving written notice from the insurer pursuant to subsection 3 concerning the appeal of the insured person.

Source: Section 689A.0403 — Procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations., https://www.­leg.­state.­nv.­us/NRS/NRS-689A.­html#NRS689ASec0403 (accessed May 26, 2025).

689A.040
Contents of policy 689A.041
Coverage relating to mastectomy. 689A.042
Coverage relating to complications of pregnancy. 689A.043
Coverage of newly born and adopted children and children placed for adoption. 689A.044
Required coverage for certain tests and vaccines relating to human papillomavirus 689A.046
Benefits for treatment of alcohol or substance use disorder. 689A.0403
Procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations. 689A.0404
Coverage for use of certain drugs for treatment of cancer. 689A.0405
Coverage for mammograms for certain women 689A.0413
Coverage for certain gynecological or obstetrical services without authorization or referral from primary care physician. 689A.0415
Coverage for hormone replacement therapy in certain circumstances 689A.0417
Coverage for health care services related to hormone replacement therapy in certain circumstances 689A.0418
Coverage for drug or device for contraception and related health services 689A.0419
Coverage for certain services, screenings and tests relating to wellness 689A.0423
Coverage for treatment of certain inherited metabolic diseases. 689A.0424
Policy that includes coverage for maternity care must not deny coverage for gestational carrier 689A.0425
Individual health benefit plan that includes coverage for maternity care and pediatric care: Requirement to allow minimum stay in hospital in connection with childbirth 689A.0427
Coverage for management and treatment of diabetes. 689A.0428
Coverage for management and treatment of sickle cell disease. 689A.0435
Coverage for autism spectrum disorders. 689A.0445
Coverage for prostate cancer screening. 689A.0447
Coverage for orally administered chemotherapy. 689A.0455
Coverage for treatment of conditions relating to severe mental illness. 689A.0463
Coverage for services provided through telehealth 689A.0465
Coverage of treatment of temporomandibular joint. 689A.04033
Coverage for treatment received as part of clinical trial or study. 689A.04036
Coverage for continued medical treatment. 689A.04042
Coverage for screening for colorectal cancer. 689A.04045
Coverage for prescription drug previously approved for medical condition of insured. 689A.04046
Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications. 689A.04047
Coverage for early refills of topical ophthalmic products.

May 26, 2025

§ 689A.0403. Proc. for arbitration of disputes concerning independent medical, dental or chiropractic evaluations.'s source at nv​.us