What information is a plan required to provide when giving notice of a claim determination that is not adverse (that has been completely granted), in the case of an urgent care or pre-service claim?
The regulation does not specify the information that must be provided in notices of benefit determinations that are not adverse. However, in accordance with the regulation s general requirement of reasonableness, the Department anticipates that such notices will contain sufficient information to fully apprise the claimant of the plan s decision to approve the requested benefit(s). See ยง 2560.503-1(f)(2)(i) and (iii) (A).
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