A new Indiana law passed last April to address the issue of out-of-network surprise billing took effect January 1, 2018.
House Bill (HB) 1273, “Out-of-Network Covered Health Services,” requires healthcare providers who make referrals to other providers to give notice to patients of possible out-of-network situations. According to the new law, the provider making a referral must provide to the covered individual an electronic or paper copy of written notice that states all the following:
- That an out of network provider may be called upon to render health care items or services to the covered individual during the course of treatment.
- That an out of network provider described in subdivision (1) is not bound by the payment provisions that apply to health care items or services rendered by a network provider under the covered individual’s health plan.
- That the covered individual may contact the covered individual’s health plan before receiving health care items or services rendered by an out of network provider described in subdivision (1):
- to obtain a list of network providers that may render the health care items or services; and
- for additional assistance.
The bill highlights several exceptions when notification is not required, including the following:
- A referral for treatment of an emergency medical condition.
- A referral made:
- immediately following treatment of an emergency medical condition; and
- by the provider that rendered the treatment of the emergency medical condition.
- A referral for medically or psychologically necessary therapeutic services rendered to an admitted patient in:
- a hospital; or
- another facility to which a patient may be admitted for more than twenty-four (24) hours.
The bill also does not affect the following types of referrals:
- to a physician in the same provider group as the referring physician,
- to a physician not specifically named,
- for a patient covered by Medicaid,
- for a patient covered by workers’ compensation insurance, or
- for a patient who is uninsured.
For more information, review a copy of the complete bill HB 1273 at the General Assembly’s website.
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