NRS 695G.150
Authorization of recommended and covered health care services required.

Each managed care organization shall authorize coverage of a health care service that has been recommended for the insured by a provider of health care acting within the scope of his or her practice if that service is covered by the health care plan of the insured, unless:

1.

The decision not to authorize coverage is made by a physician who:

(a)

Is licensed to practice medicine in the State of Nevada pursuant to chapter 630 or 633 of NRS;

(b)

Possesses the education, training and expertise to evaluate the medical condition of the insured; and

(c)

Has reviewed the available medical documentation, notes of the attending physician, test results and other relevant medical records of the insured.
Ê The physician may consult with other providers of health care in determining whether to authorize coverage.

2.

The decision not to authorize coverage and the reason for the decision have been transmitted in writing in a timely manner to the insured, the provider of health care who recommended the service and the primary care physician of the insured, if any.

Source: Section 695G.150 — Authorization of recommended and covered health care services required., https://www.­leg.­state.­nv.­us/NRS/NRS-695G.­html#NRS695GSec150.

695G.150
Authorization of recommended and covered health care services required. 695G.155
Requirements regarding issuance of health benefit plans and adjustment of costs. 695G.160
Written criteria concerning coverage of health care services and standards for quality of health care services. 695G.162
Required provision concerning coverage for services provided through telehealth. 695G.163
Coverage for prescription drugs: Provision of notice and information regarding use of formulary. 695G.164
Required provision concerning coverage for continued medical treatment. 695G.166
Required provision concerning coverage for prescription drug previously approved for medical condition of insured. 695G.167
Required provision concerning coverage for orally administered chemotherapy. 695G.168
Required provision concerning coverage for screening for colorectal cancer. 695G.170
Required provision concerning coverage for medically necessary emergency services 695G.171
Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus 695G.172
Required provision concerning coverage for early refills of topical ophthalmic products. 695G.173
Required provision concerning coverage for treatment received as part of clinical trial or study. 695G.174
Required provision concerning coverage for management and treatment of sickle cell disease. 695G.175
Certain actions of managed care organization prohibited. 695G.177
Required provision concerning coverage for prostate cancer screening. 695G.1645
Required provision concerning coverage for autism spectrum disorders. 695G.1665
Required provision concerning coverage for prescription drugs irregularly dispensed for purpose of the synchronization of chronic medications. 695G.1713
Required provision concerning coverage for mammograms for certain women 695G.1715
Required provision concerning coverage for drug or device for contraception and related health services 695G.1716
Health care plan that includes coverage for maternity care must not deny coverage for gestational carrier 695G.1717
Coverage for certain services, screenings and tests relating to wellness
Last Updated

Feb. 5, 2021

§ 695G.150’s source at nv​.us