Health & Saf. Code, § 1371.36 · Article 5. Standards
Health & Saf. Code, § 1371.36
Text — As published in the Legislative Counsel's database, tables dated October 18, 2026 (pubinfo_2025.zip)
(a) A health care service plan shall not deny payment of a claim on the basis that the plan, medical group, independent practice association, or other contracting entity did not provide authorization for health care services that were provided in a licensed acute care hospital and that were related to services that were previously authorized, if all of the following conditions are met:
(1) It was medically necessary to provide the services at the time.
(2) The services were provided after the plan’s normal business hours.
(3) The plan does not maintain a system that provides for the availability of a plan representative or an alternative means of contact through an electronic system, including voicemail or electronic mail, whereby the plan can respond to a request for authorization within 30 minutes of the time that a request was made.
(b) This section shall not apply to investigational or experimental therapies, or other noncovered services.
Notes and commentary — not statutory text
History
Added by Stats. 2000, Ch. 827, Sec. 5. Effective January 1, 2001.
Source of truth
- Edition
- As published in the Legislative Counsel's database, tables dated October 18, 2026 (pubinfo_2025.zip)
- Official file
- https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=1371.36.
- Text hash
- sha256 9741442198d4354ac609f81d293b149e5cf9d2525278123196c3969b370012df
- Composed by
- compose_ca.py 2026-10-22: the Legislative Counsel's CAML content files read by a tokenizer (caml_readers.reader_a); an independent xml.etree reading (caml_readers.reader_b) agrees on every section
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.