Page 75

Effective Date:

Approval Date: 75

UnitedHealthcare Wellmark Health Plan of Iowa Delta Dental of Iowa Insurance nor shall it preclude the Department of Insurance from investigating a complaint persusant to its authority under section 4-6 of The HMO Act. denial of benefits based on medical necessity, the Enrollee or the provider acting on behalf of the Enrollee may request a decision of the Wellmark's decision with the Iowa Insurance Commissioner. This request must be filed in writing no later than 60 days following Wellmark's decision. Other review If a member is dissatisfied with the decision of the Member Grievance Committee, he or she may file a request for arbitration with UHC in writing within six months of the date of the decision. Arbitration shall be conducted in accordance with the Rules of the American Health Lawyers Association Alternative Dispute Resolution Service. The parties waive their right to jury trial, except for enforcement of the decision of the arbitrator. NA NA