NRS 695A.188
Approval or denial of claim

  • interest on unpaid claim
  • request for additional information
  • payment of claim
  • costs and attorney’s fees.

1.

Except as otherwise provided in subsection 2, a society shall approve or deny a claim relating to a certificate of health insurance within 30 days after the society receives the claim. If the claim is approved, the society shall pay the claim within 30 days after it is approved. If the approved claim is not paid within that period, the society shall pay interest on the claim at the rate of interest established pursuant to NRS 99.040 unless a different rate of interest is established pursuant to an express written contract between the society and the provider of health care. The interest must be calculated from 30 days after the date on which the claim is approved until the claim is paid.

2.

If the society requires additional information to determine whether to approve or deny the claim, it shall notify the claimant of its request for the additional information within 20 days after it receives the claim. The society shall notify the provider of health care of all the specific reasons for the delay in approving or denying the claim. The society shall approve or deny the claim within 30 days after receiving the additional information. If the claim is approved, the society shall pay the claim within 30 days after it receives the additional information. If the approved claim is not paid within that period, the society shall pay interest on the claim in the manner prescribed in subsection 1.

3.

A society shall not request a claimant to resubmit information that the claimant has already provided to the society, unless the society provides a legitimate reason for the request and the purpose of the request is not to delay the payment of the claim, harass the claimant or discourage the filing of claims.

4.

A society shall not pay only part of a claim that has been approved and is fully payable.

5.

A court shall award costs and reasonable attorney’s fees to the prevailing party in an action brought pursuant to this section.

Source: Section 695A.188 — Approval or denial of claim; interest on unpaid claim; request for additional information; payment of claim; costs and attorney’s fees., https://www.­leg.­state.­nv.­us/NRS/NRS-695A.­html#NRS695ASec188.

695A.001
Definitions. 695A.003
“Benefit contract” defined. 695A.004
“Benefit member” defined. 695A.006
“Certificate” defined. 695A.010
“Fraternal benefit society” defined. 695A.014
“Insurer” defined. 695A.016
“Laws” defined. 695A.018
“Lodge” defined. 695A.020
“Lodge system” defined. 695A.023
“Medicaid” defined. 695A.027
“Order for medical coverage” defined. 695A.030
“Premiums” defined. 695A.040
“Representative form of government” defined. 695A.042
“Rules” defined. 695A.044
“Society” defined. 695A.050
Organization: Preparation and contents of articles of incorporation. 695A.060
Organization: Filing of documents and bond with Commissioner 695A.070
Organization: Solicitation of members 695A.080
Certificate of authority: Issuance and renewal 695A.090
General powers and duties of society. 695A.095
Contracts between society and provider of health care: Prohibiting society from charging provider of health care fee for inclusion on list of providers given to insureds 695A.110
Unincorporated or voluntary association prohibited. 695A.120
Location of principal office 695A.130
Consolidation 695A.140
Conversion of fraternal benefit society into mutual life insurer. 695A.150
Qualifications for and rights and privileges of membership. 695A.151
Effect of eligibility for medical assistance under Medicaid on eligibility for coverage 695A.152
Society required to comply with certain provisions concerning portability and availability of health insurance. 695A.153
Society prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order. 695A.155
Certain accommodations to be made when child is covered under policy of noncustodial parent. 695A.157
Society to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances 695A.159
Society prohibited from restricting coverage of child based on preexisting condition when person who is eligible for group coverage adopts or assumes legal obligation for child. 695A.160
Amendment of laws of society. 695A.180
Scope of contractual benefits. 695A.184
Coverage for prescription drug previously approved for medical condition of insured. 695A.188
Approval or denial of claim 695A.195
Society prohibited from denying coverage solely because person was victim of domestic violence. 695A.197
Society prohibited from denying coverage solely because insured was intoxicated or under the influence of controlled substance 695A.200
Nonforfeiture benefits, cash surrender values, certificate loans and other options. 695A.210
Beneficiaries 695A.220
Benefits not liable to attachment, garnishment or other process. 695A.230
Terms and conditions of benefit contracts. 695A.232
Requirements regarding issuance of health benefit plans and adjustment of costs. 695A.235
Offering policy of health insurance for purposes of establishing health savings account. 695A.240
Approval and contents of certificates. 695A.255
Coverage for prescription drugs: Provision of notice and information regarding use of formulary. 695A.265
Coverage for services provided through telehealth. 695A.270
Waiver of provisions of society’s laws. 695A.280
Reinsurance. 695A.300
Admission of foreign or alien society. 695A.310
Injunction against, liquidation of or appointment of receiver for domestic society. 695A.320
Suspension, revocation or refusal of license of foreign or alien society. 695A.330
Licensing of insurance agents of society 695A.400
Service of process on society. 695A.410
Injunctions against societies. 695A.420
Judicial review of Commissioner’s findings and decisions. 695A.430
Assets, funds and accounts of society. 695A.440
Investments. 695A.450
Annual statement of financial condition, transactions and affairs. 695A.460
Penalties for failure to file statement properly. 695A.475
Liability of directors, officers, employees, members and volunteers 695A.490
Standards of valuation for certificates. 695A.500
Examination of societies transacting business in State. 695A.530
Applicability of statutory provisions relating to trade practices and frauds. 695A.550
Exemption of societies from certain taxes. 695A.555
Fees: Applicability of certain provisions. 695A.560
Exemption of societies from other insurance laws. 695A.570
Applicability. 695A.580
Penalties. 695A.1845
Required coverage for certain tests and vaccines relating to human papillomavirus 695A.1855
Coverage for mammograms for certain women 695A.1857
Benefit contract that includes coverage for maternity care must not deny coverage to gestational carrier 695A.1865
Coverage for drug or device for contraception and related health services in certain circumstances 695A.1873
Coverage for management and treatment of sickle cell disease. 695A.1875
Coverage for certain services, screenings and tests relating to wellness
Last Updated

Jun. 24, 2021

§ 695A.188’s source at nv​.us