Health insurance plans; certificate requirement; contract with private review agent; reimbursement under policy where medical necessity in dispute.

Miss. Code Ann. § 41-83-25
in effect
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Every health insurance plan proposing to issue or deliver a health insurance policy or contract or administer a health benefit program which provides for the coverage of hospital and medical benefits and the utilization review of those benefits shall: Have a certificate in accordance with this chapter; or Contract with a private review agent who has a certificate in accordance with this chapter. Notwithstanding any other provisions of this chapter, for claims where the medical necessity of the provision of a covered benefit is disputed, a health service plan that does not meet the requirements of subsection (1) of this section shall pay any person or hospital entitled to reimbursement under the policy or contract.

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