(a) The period described in Section 127455 shall be extended if the patient has a pending appeal for coverage of the services, until a final determination of that appeal is made, if the patient makes a reasonable effort to communicate with the emergency physician about the progress of any pending appeals.
(b) For purposes of this section, “pending appeal” includes any of the following:
(1) A grievance against a contracting health care service plan, as described in Chapter 2.2 (commencing with Section 1340) of Division 2, or against an insurer, as described in Chapter 1 (commencing with Section 10110) of Part 2 of Division 2 of the Insurance Code.
(2) An independent medical review, as described in Section 10145.3 or 10169 of the Insurance Code.
(3) A fair hearing for a review of a Medi-Cal claim pursuant to Section 10950 of the Welfare and Institutions Code.
(4) An appeal regarding Medicare coverage consistent with federal law and regulations.
(Added by Stats. 2010, Ch. 445, Sec. 4. (AB 1503) Effective January 1, 2011.)
Last modified: October 25, 2018