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Official Code of Georgia Annotated

Title 33. INSURANCE · Chapter 20A. MANAGED HEALTH CARE PLANS · Article 2. PATIENT’S RIGHT TO INDEPENDENT REVIEW

33-20A-40. Determining medical necessity or whether a treatment is experimental.

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Current through: Including Acts of the 2025 Regular Session of the General Assembly.

  1. (a)

    For the purposes of this article, in making a determination as to whether a treatment is medically necessary and appropriate, the expert reviewer shall use the definition provided in paragraph (7) of Code Section 33-20A-31.#

  2. (b)

    For the purposes of this article, in making a determination as to whether a treatment is experimental, the expert reviewer shall determine:#

    1. (1)

      Whether such treatment has been approved by the federal Food and Drug Administration; or#

    2. (2)

      Whether medical and scientific evidence demonstrates that the expected benefits of the proposed treatment would be greater than the benefits of any available standard treatment and that the adverse risks of the proposed treatment will not be substantially increased over those of standard treatments.#

    3. For either determination, the expert reviewer shall apply prudent professional practices and shall assure that at least two documents of medical and scientific evidence support the decision.

The notes below are printed with the section but are not enacted law (O.C.G.A. § 1-1-1(c)). They are shown apart from the text.

History

Code 1981, § 33-20A-40, enacted by Ga. L. 1999, p. 350, § 3; Ga. L. 2005, p. 1438, § 2/SB 140.

Read the official page (the state's PDF, opened at the page this text was read from).

Current through: Including Acts of the 2025 Regular Session of the General Assembly.

Text read from t33-ch1-22-(v24)-2020-pdf.pdf, Volume V24, 2020 edition, pages 834 to 835; merge action: carried; file SHA-256 4ecec175d949.