Independent Medical Reviews – Experimental and Investigational Therapies – 28 C.C.R. § 1300.70.4

This regulation, effective July 2005, describes the requirements for a plan’s notice to its enrollee when denying coverage on the basis of the treatments’ experimental or investigational status, when it is appropriate to request an IMR for this reason, and the procedure for requesting an IMR. Notably, enrollees applying for IMR under this regulation are not required to participate in the health plan’s grievance system first. [Download]