NRS 695C.265
Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations.

1.

If a health maintenance organization, 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 provided under the evidence of coverage:

(a)

The evidence of coverage must include a procedure for binding arbitration to resolve disputes concerning independent medical evaluations pursuant to the rules of the American Arbitration Association; and

(b)

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.

2.

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 evidence of coverage 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.

3.

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 2 concerning the appeal of the insured person.

Source: Section 695C.265 — Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations., https://www.­leg.­state.­nv.­us/NRS/NRS-695C.­html#NRS695CSec265.

695C.010
Short title. 695C.020
Legislative declaration. 695C.030
Definitions. 695C.050
Applicability of certain provisions. 695C.055
Applicability of certain other provisions. 695C.057
Applicability of certain provisions concerning portability and availability of health insurance. 695C.060
Establishment of organization. 695C.070
Certificate of authority: Application. 695C.080
Certificate of authority: Evaluation of application. 695C.090
Certificate of authority: Issuance. 695C.100
Certificate of authority: Denial. 695C.110
Governing body: Composition 695C.120
Powers of organization. 695C.123
Contracts with certain federally qualified health centers. 695C.125
Contract between health maintenance organization and provider of health care: Form to obtain information on provider of health care 695C.128
Contracts to provide services pursuant to certain state programs: Payment of interest on claims. 695C.130
Notice and approval required for exercise of powers 695C.140
Notice and approval required for modification of operations 695C.145
Accounting principles required for certain reports and transactions 695C.150
Fiduciary responsibilities. 695C.160
Investments. 695C.161
Eligibility for coverage: Definitions. 695C.163
Eligibility for coverage: Effect of eligibility for medical assistance under Medicaid 695C.165
Eligibility for coverage: Organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is enrolled in health care plan. 695C.167
Eligibility for coverage: Certain accommodations to be made when child is covered under health care plan of noncustodial parent. 695C.169
Eligibility for coverage: Organization to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances 695C.170
Evidence of coverage: Issuance 695C.171
Required provision concerning coverage relating to mastectomy. 695C.172
Required provision concerning coverage relating to complications of pregnancy. 695C.173
Required provision concerning coverage for newly born and adopted children and children placed for adoption. 695C.176
Required provision concerning coverage for hospice care. 695C.177
Reimbursement for treatments by licensed psychologist. 695C.178
Reimbursement for treatment by chiropractor. 695C.179
Reimbursement for services provided by certain nurses 695C.185
Approval or denial of claims 695C.187
Schedule for payment of claims: Mandatory inclusion in arrangements for provision of health care. 695C.190
Commissioner may require submission of information. 695C.194
Provision of health care services to recipients of Medicaid or enrollees in Children’s Health Insurance Program: Requirement to contract with psychiatric hospital for inclusion in network of providers. 695C.200
Approval of forms and schedules. 695C.201
Offering policy of health insurance for purposes of establishing health savings account. 695C.202
Provision of health care services to recipients of Medicaid: Notice to recipients if Department of Health and Human Services obtains waiver to provide dental care to persons with diabetes 695C.203
Denying coverage solely because person was victim of domestic violence prohibited. 695C.205
Denying coverage solely because insured was intoxicated or under the influence of controlled substance prohibited 695C.207
Requiring or using information concerning genetic testing. 695C.210
Annual report of financial condition and financial statement 695C.215
Financial statement required to include report of net worth. 695C.220
Applications, filings and reports open to public inspection. 695C.230
Fees. 695C.240
Information required to be available for inspection. 695C.260
Complaint system. 695C.265
Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations. 695C.267
Provision requiring binding arbitration authorized 695C.270
Bond required 695C.275
Commissioner to adopt regulations for licensing of provider-sponsored organizations. 695C.280
Commissioner authorized to adopt regulations for licensing of agents or brokers. 695C.290
Insurance company may establish or contract with health maintenance organization. 695C.300
Prohibited practices. 695C.310
Examinations: Affairs of and compliance program used by health maintenance organization 695C.311
Periodic examination by Commissioner to determine financial condition of health maintenance organization. 695C.313
Financial examination: Procedure 695C.315
Financial examination: Payment of expense. 695C.317
Statutory procedures required for examination and hearing. 695C.318
Insolvency 695C.319
Power of Commissioner to order corrective action for hazardous operation or violation of law 695C.320
Rehabilitation, liquidation or conservation. 695C.325
Authorization to offer health care plan to small employer for purpose of establishing medical savings accounts. 695C.326
Health maintenance organization to provide data relating to claims and costs to person responsible for overseeing health care plan upon request 695C.328
Disclosure of data relating to claims and costs prohibited 695C.330
Disciplinary proceedings: Grounds 695C.340
Disciplinary proceedings: Notice 695C.350
Violations: Remedies 695C.1691
Required provision concerning coverage for continued medical care. 695C.1693
Required provision concerning coverage for treatment received as part of clinical trial or study. 695C.1694
Required provision concerning coverage of hormone replacement therapy in certain circumstances 695C.1695
Required provision concerning coverage of health care services related to hormone replacement therapy in certain circumstances 695C.1696
Required provision concerning coverage for drug or device for contraception and related health services 695C.1698
Required provision concerning coverage for certain services, screenings and tests relating to wellness 695C.1701
Requirements regarding issuance of health benefit plans and adjustment of costs. 695C.1703
Coverage for prescription drugs: Provision of notice and information regarding use of formulary. 695C.1705
Group health care plan issued to replace discontinued policy or coverage: Requirements 695C.1708
Required provision concerning coverage for services provided through telehealth. 695C.1709
Required provision concerning coverage for enrollee on leave without pay as result of total disability. 695C.1712
Health care plan that includes coverage for maternity care must not deny coverage for gestational carrier 695C.1713
Required provision concerning coverage of certain gynecological and obstetrical services without authorization or referral from primary care physician. 695C.1717
Required provision concerning coverage for autism spectrum disorders. 695C.1723
Required provision concerning coverage for treatment of certain inherited metabolic diseases. 695C.1727
Required provision concerning coverage for management and treatment of diabetes. 695C.1728
Required provision concerning coverage for management and treatment of sickle cell disease. 695C.1731
Required provision concerning coverage for screening for colorectal cancer. 695C.1733
Required provision concerning coverage for certain drugs for treatment of cancer. 695C.1734
Required provision concerning coverage for prescription drug previously approved for medical condition of enrollee. 695C.1735
Required provision concerning coverage for mammograms for certain women 695C.1745
Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus 695C.1751
Required provision concerning coverage for prostate cancer screening. 695C.1755
Required provision concerning coverage for treatment of temporomandibular joint. 695C.1757
Required provision concerning coverage for early refills of topical ophthalmic products. 695C.1765
Reimbursement for acupuncture. 695C.1773
Reimbursement for treatment by licensed marriage and family therapist or licensed clinical professional counselor. 695C.1775
Reimbursement for treatment by licensed associate in social work, social worker, independent social worker or clinical social worker. 695C.1783
Reimbursement for treatment by podiatrist. 695C.1789
Reimbursement for treatment by licensed clinical alcohol and drug abuse counselor. 695C.1795
Reimbursement to provider of medical transportation. 695C.3175
Required contract with insurance company for provision of insurance, indemnity or reimbursement against cost of health care services 695C.3185
Plan for continuation of benefits if health maintenance organization becomes insolvent or impaired 695C.3195
Conservation, rehabilitation or liquidation of health maintenance organization: Powers of Commissioner 695C.17335
Required provision concerning coverage for orally administered chemotherapy. 695C.17345
Required provision concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications.
Last Updated

Feb. 5, 2021

§ 695C.265’s source at nv​.us