Ohio § 1751.82

§ 1751.82.

(A) In a case involving a prospective determination or a concurrent review determination,

a health insuring corporation shall give the provider or health care facility rendering

the health care service an opportunity to request in writing on behalf of the enrollee

a reconsideration of an adverse determination by the reviewer making the adverse determination.  The provider or health care facility may not request a reconsideration without the

prior consent of the enrollee.  The reconsideration shall occur within three business days after the health insuring

corporation's receipt of the written request for reconsideration, and shall be conducted

between the provider or health care facility rendering the health care service and

the reviewer who made the adverse determination.  If that reviewer cannot be available within three business days, the reviewer may

designate another reviewer. (B) If the reconsideration process described in division (A) of this section does not

resolve the difference of opinion, the enrollee, an authorized person, or the provider

or health care facility acting on behalf of the enrollee may request an internal review

under section 1751.83 of the Revised Code .  The provider or health care facility may not request an internal review without

the prior consent of the enrollee. (C) Reconsideration is not a prerequisite to an internal or external review of an adverse

determination. (D) The time period allowed by division (A) of this section for a reconsideration of

an adverse determination shall not apply if the seriousness of the medical condition

of the enrollee requires a more expedited reconsideration.  The health insuring corporation shall maintain written procedures for making such

an expedited reconsideration.