AB876-AA11,2,2
6"2. The insurer includes on its explanation of benefits form a statement that
7the insured may have a right to an independent review after the internal grievance
8process and that an insured may be entitled to expedited independent review with
9respect to an urgent matter. The statement shall also include a reference to the
10section of the policy or certificate that contains the description of the independent
11review procedure as required under subd. 1. The statement shall provide a toll-free
12telephone number and website, if appropriate, where consumers may obtain
1additional information regarding internal grievance and independent review
2processes.
AB876-AA11,2,123
3. For any adverse determination or experimental treatment determination for
4which an explanation of benefits is not provided to the insured, the insurer provides
5a notice that the insured may have a right to an independent review after the
6internal grievance process and that an insured may be entitled to expedited,
7independent review with respect to an urgent matter. The notice shall also include
8a reference to the section of the policy or certificate that contains the description of
9the independent review procedure as required under subd. 1. The notice shall
10provide a toll-free telephone number and website, if appropriate, where consumers
11may obtain additional information regarding internal grievance and independent
12review processes.".
