Adverse Determination Denial Rate

HMSA is required by the settlement in Love v. Blue Cross and Blue Shield Association, et al. to disclose the number of Adverse Determinations sent to the external review process required by the settlement during the preceding calendar year.

An "Adverse Determination" is a determination made by HMSA that a service is not covered because it is not medically necessary or is experimental or investigational in nature.

For calendar year 2010, no Adverse Determinations were sent through the external review process.

Revision History