# Mont. Code Ann. § 33-32-215: 33-32-215 Emergency services > Montana · Statutes · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-215 ## Section - **Citation:** Mont. Code Ann. § 33-32-215 - **Heading:** 33-32-215 Emergency services - **Jurisdiction:** Montana - **Kind:** Statutes - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** MT Code / Title 33 / Chapter 32 / Part 2 / Section 33-32-215 ## Text 33-32-215 . Emergency services. (1) When conducting a utilization review or making a benefit determination for emergency services, a health insurance issuer that provides benefits for services in an emergency department of a hospital shall follow the provisions of this section. (2) A health insurance issuer shall cover emergency services that screen and stabilize a covered person: (a) without the need for prior authorization of the emergency services if a prudent lay person would have reasonably believed that an emergency medical condition existed even if the emergency services are provided on an out-of-network basis; (b) without regard to whether the health care provider furnishing the services is a participating provider with respect to the emergency services; (c) if the emergency services are provided out-of-network, without imposing any administrative requirement or limitation on coverage that is more restrictive than the requirements or limitations that apply to emergency services received from network providers; (d) if the emergency services are provided out-of-network, by complying with the cost-sharing requirements in subsection (4); and (e) without regard to any other term or condition of coverage, other than: (i) the exclusion of or coordination of benefits; (ii) an affiliation or waiting period as permitted under 42 U.S.C. 300gg-19a; or (iii) cost-sharing, as provided in subsection (4)(a). (3) For in-network emergency services, coverage of emergency services is subject to applicable copayments, coinsurance, and deductibles. (4) (a) Only in-network cost sharing amounts may be imposed on out-of-network emergency services. (b) A health insurance issuer complies with the requirements of this section by paying for emergency services provided by an out-of-network provider in an amount not less than the greatest of the following and taking into account exceptions in subsections (4)(c) and (4)(d): (i) the amount negotiated with in-network providers for emergency services, excluding any in-network cost-sharing imposed with respect to the covered person; (ii) the amount of the emergency service calculated using the same method the plan uses to determine payments for out-of-network services but using the in-network cost-sharing provisions instead of the out-of-network cost-sharing provisions; or (iii) the amount that would be paid under medicare for the emergency services, excluding any in-network cost-sharing requirements. (c) For capitated or other health plans that do not have a negotiated charge for each service for in-network providers, subsection (4)(b)(i) does not apply. (d) If a health plan has more than one negotiated amount for in-network providers for a particular emergency service, the amount in subsection (4)(b)(i) is the median of those negotiated amounts. (5) A health insurance issuer shall allow a covered person, the person's authorized representative, and the person's health care provider at least 24 hours following an emergency admission or the provision of emergency services to notify the health insurance issuer of the admission or provision of emergency services. If the admission or the emergency services occur on a holiday or weekend, a health insurance issuer shall allow notification no later than by the next business day following the admission or provision of emergency services. (6) If prior authorization is required for a postevaluation or poststabilization services review, a health insurance issuer shall provide access to a designated representative 24 hours a day, 7 days a week, to facilitate the review. ## Nearby sections - [Mont. Code Ann. § 33-32-202 33-32-202 Commissioner not to approve or disapprove plans](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-202.md) - [Mont. Code Ann. § 33-32-205 33-32-205 Corporate oversight of utilization review program](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-205.md) - [Mont. Code Ann. § 33-32-206 33-32-206 Responsibility for contracted services](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-206.md) - [Mont. Code Ann. § 33-32-207 33-32-207 Health insurance issuer duties for utilization review](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-207.md) - [Mont. Code Ann. § 33-32-208 33-32-208 Operational requirements](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-208.md) - [Mont. Code Ann. § 33-32-209 33-32-209 Exemption for continuity of care on change in health plans](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-209.md) - [Mont. Code Ann. § 33-32-210 33-32-210 Qualifications of individuals making or reviewing adverse determinations](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-210.md) - [Mont. Code Ann. § 33-32-211 33-32-211 Procedures for standard utilization review and benefit determinations -- notices](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-211.md) - [Mont. Code Ann. § 33-32-212 33-32-212 Procedures for expedited utilization review and benefit determinations](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-212.md) - [Mont. Code Ann. § 33-32-215 33-32-215 Emergency services](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-215.md) - [Mont. Code Ann. § 33-32-216 33-32-216 Confidentiality](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-216.md) - [Mont. Code Ann. § 33-32-217 33-32-217 Disclosure](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-217.md) - [Mont. Code Ann. § 33-32-221 33-32-221 Prior authorization requirements](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-221.md) - [Mont. Code Ann. § 33-32-222 33-32-222 Prohibition on prior authorization requirements for prescriptions written at discharge from inpatient care](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-222.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-215. Check the current official text before relying on it. Not legal advice.