An insurer shall establish and maintain an external grievance procedure for the resolution of external grievances regarding the following:

1. (1) The following determinations made by the insurer or an agent of the insurer regarding a service proposed by the treating health care provider:

   1. (A) An adverse determination of appropriateness.
   2. (B) An adverse determination of medical necessity.
   3. (C) A determination that a proposed service is experimental or investigational.
   4. (D) A denial of coverage based on a waiver described in IC 27-8-5-2.5 (e) (expired July 1, 2007, and removed) or IC 27-8-5-19.2 (expired July 1, 2007, and repealed).
2. (2) The insurer's decision to rescind an accident and sickness insurance policy.

As added by P.L.66-2001, SEC.3 and P.L.203-2001, SEC.14. Amended by P.L.211-2003, SEC.7; P.L.3-2008, SEC.216; P.L.160-2011, SEC.23.