Cal. Health and Safety Code § 1371.36
Cal. Health and Safety Code § 1371.36
California · California Health and Safety Code · Status: effective · Effective 2001-01-01
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- Citation
- Cal. Health and Safety Code § 1371.36, California, version 1 as recorded 2026-07-25, yourstate.us, https://yourstate.us/provision/857579
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Full text
(a) A health care service plan shall not deny payment of a claim on the basis that the plan, medical group, independent practice association, or other contracting entity did not provide authorization for health care services that were provided in a licensed acute care hospital and that were related to services that were previously authorized, if all of the following conditions are met:
(1) It was medically necessary to provide the services at the time.
(2) The services were provided after the plan’s normal business hours.
(3) The plan does not maintain a system that provides for the availability of a plan representative or an alternative means of contact through an electronic system, including voicemail or electronic mail, whereby the plan can respond to a request for authorization within 30 minutes of the time that a request was made.
(b) This section shall not apply to investigational or experimental therapies, or other noncovered services.