A.__The decision to be reviewed must require the health plan to incur at least $100 in expenditures and the health plan's decision must have been based on one of the following reasons.

(1)__The health care service is a covered benefit that the carrier has determined to be not medically necessary.

(2)__A limitation is placed on the selection of a health care provider that is claimed by the enrollee to be inconsistent with limits imposed by the health plan and any applicable laws and rules.

(3)__The health care treatment has been determined to be experimental or investigational.

(4)__The health care service involves a medically based decision that a condition is preexisting.

B.__The independent external review must be requested in writing by the affected enrollee and the enrollee must pay a filing fee of not more than $50 that reflects the administrative costs of processing a request for review under this subsection.__The filing fee may be waived or reduced based on a determination by the superintendent that the financial circumstances of the enrollee warrant a waiver or reduction.

C.__Enrollees may use outside assistance during the review process and submit evidence relating to the health care service.

D.__Independent external reviews must be conducted by independent review organizations pursuant to a contract with the bureau.__The reviewers must be health care providers credentialed with respect to the health care service under review and have no conflict of interest relating to the performance of their duties under this subsection.

E.__The independent review organization shall issue a written review decision based on the evidence presented to the health plan and the enrollee.__The decision