Louisiana § RS 22:1060.4 - Adverse determination
Full text of Louisiana Louisiana Civil Code § RS 22:1060.4 — Adverse determination, with citation guidance and answers to common questions.
§ RS 22:1060.4. Adverse determination
A. The refusal of a health insurance issuer to provide benefits to an enrollee for a prescription drug is an adverse determination for purposes of the Internal Claims and Appeals Process and External Review Act, R.S. 22:2391 et seq., if each of the following conditions is met:
(1) The drug is not included in a drug formulary used by the health benefit plan.
(2) The enrollee's physician or other authorized prescriber has determined the drug is medically necessary.
B. The enrollee may appeal the adverse determination pursuant to the Internal Claims and Appeals Process and External Review Act, R.S. 22:2391 et seq.
Acts 2011, No. 350, §1, eff. Jan. 1, 2012; Acts 2016, No. 573, §1, eff. Jan. 1, 2017.
Frequently Asked Questions About Louisiana § RS 22:1060.4
What does Louisiana Civil Code § RS 22:1060.4 cover?
Section RS 22:1060.4 ("Adverse determination") is part of the Louisiana Civil Code, the codified statutory law of Louisiana. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite Louisiana § RS 22:1060.4?
A common citation format is "Louisiana Civil Code § RS 22:1060.4" (Louisiana). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of Louisiana law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Louisiana official source linked on this page or consult a licensed Louisiana attorney.
How does Louisiana § RS 22:1060.4 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Louisiana can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in Louisiana.