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Procedure for denial of benefits, Colo. Rev. Stat. § 10-16-113
Link to the law
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Procedure for denial of benefits - internal review - rules
Requires health insurance carriers to notify individuals upon making an adverse determination. Specifies the information that must be included in the notice (e.g., the basis for the determination, appeals procedures, etc.). Requires carriers of group coverage to use a two-level internal review process and carriers of individual coverage to use a single-level internal review process. Permits individuals to seek an external review upon exhausting their internal review procedures. Requires carriers to maintain records of their internal reviews and to make these records available for inspection by the Division of Insurance, federal government, or covered persons.
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